Embolotherapy of unresectable hepatocellular carcinoma: Eastern perspective

Asia suffers a particularly large prevalence of the world's hepatocellular carcinoma (HCC), accounting for nearly 72.5% of the newly diagnosed 609,596 cases and 72.4% of the 566,269 deaths. The majority of HCC patients is diagnosed at unresectable stages in Asia despite efforts to improve availability of screening. Although the Barcelona Clinic Liver Cancer (BCLC) staging algorithm is accepted worldwide, various staging systems and guidelines have been proposed in Asian regions. Embolotherapy has been endorsed by many Asian guidelines and is the most common treatment across all stages of HCC. There are considerable discrepancies of the allocation of embolotherapy for unresectable HCC in Asia. This review will focus on the indication and contraindication, technique variances, combination regimen, and when to start, repeat or stop embolotherapy for unresectable HCC with the hope to provide insights into TACE application to patients at any HCC stage.