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Re‐evaluating transarterial chemoembolization for the treatment of Hepatocellular Carcinoma: Consensus recommendations and review by an International Expert Panel
Author(s) -
Cheng Ann Lii,
Amarapurkar Deepak,
Chao Yee,
Chen PeiJer,
Geschwind JeanFrançois,
Goh Khean L.,
Han KwangHyub,
Kudo Masatoshi,
Lee Han Chu,
Lee RheunChuan,
Lesmana Laurentius A.,
Lim Ho Yeong,
Paik Seung Woon,
Poon Ronnie T.,
Tan CheeKiat,
Tanwandee Tawesak,
Teng Gaojun,
Park JoongWon
Publication year - 2014
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12314
Subject(s) - medicine , hepatocellular carcinoma , stage (stratigraphy) , expert opinion , psychological intervention , clinical practice , consensus conference , intensive care medicine , transcatheter arterial chemoembolization , oncology , physical therapy , paleontology , psychiatry , biology
Abstract Patients with unresectable hepatocellular carcinoma ( HCC ) usually receive transarterial chemoembolization ( TACE ) or systemic therapies with intermediate and advanced‐stage disease. However, intermediate‐stage HCC patients often have unsatisfactory clinical outcomes with repeated TACE and there is considerable uncertainty surrounding the criteria for repeating or stopping TACE treatment. In July 2012, an Expert Panel Opinion on Interventions in Hepatocellular Carcinoma ( EPOIHCC ) was re‐convened in Shanghai in an attempt to provide a consensus on the practice of TACE , particularly in regard to evaluating TACE ‘failure’. To that end, current clinical practice throughout Asia was reviewed in detail including safety and efficacy data on TACE alone as well as in combination with targeted systemic therapies for intermediate HCC . This review summarizes the evidence discussed at the meeting and provides expert recommendations regarding the use of TACE for unresectable intermediate‐stage HCC . A key consensus of the Expert Panel was that the current definitions of TACE failure are not useful in differentiating between situations where TACE is no longer effective in controlling disease locally vs. systemically. By redefining these concepts, it may be possible to provide a clearer indication of when TACE should be repeated and more importantly, when TACE should be discontinued.