Department of Medical Oncology, Centre E. Marquis, INSERM U991 and Rennes University, Rennes, France.
Cancer Treat Rev. 2011 May;37(3):212-20. doi: 10.1016/j.ctrv.2010.07.006. Epub 2010 Aug 17.
Transarterial chemoembolization (TACE) is considered the gold standard for treating intermediate-stage hepatocellular carcinoma (HCC). However, intermediate-stage HCC includes a heterogeneous population of patients with varying tumour burdens, liver function (Child-Pugh A or B) and disease aetiology. This suggests that not all patients with intermediate-stage HCC will derive similar benefit from TACE, and that some patients may benefit from other treatment options. Results of an extensive literature review into the treatment of unresectable HCC with TACE were combined with our own clinical experience to identify factors that may predict survival after TACE. We also report contraindications to TACE and propose a treatment algorithm for the repetition of TACE. In addition, we have constructed a number of expert opinions that may be used as a guide to help physicians make treatment decisions for their patients with intermediate-stage HCC. The data included in the literature review related almost exclusively to conventional TACE, rather than to TACE with drug-eluting beads. Therefore, the findings and conclusions of the literature review are only applicable to the treatment of HCC with conventional TACE. Treating physicians may want to consider other treatment options for patients with intermediate-stage HCC who are not suitable for or do not respond to TACE. By distinguishing those patients who represent good candidates for TACE from those where little or no benefit might be expected, it may be possible to make better use of current treatment options and improve outcomes for patients.
经动脉化疗栓塞术（TACE）被认为是治疗中期肝细胞癌（HCC）的金标准。然而，中期 HCC 包括肿瘤负荷、肝功能（Child-Pugh A 或 B）和疾病病因不同的异质性患者群体。这表明，并非所有中期 HCC 患者都能从 TACE 中获得相似的益处，有些患者可能受益于其他治疗选择。对 TACE 治疗不可切除 HCC 的广泛文献综述结果结合我们自己的临床经验，确定了可能预测 TACE 后生存的因素。我们还报告了 TACE 的禁忌症，并提出了 TACE 重复治疗的算法。此外，我们还构建了一些专家意见，可作为帮助医生为其中期 HCC 患者做出治疗决策的指南。文献综述中包含的数据几乎完全与传统 TACE 相关，而不是与载药微球 TACE 相关。因此，文献综述的发现和结论仅适用于常规 TACE 治疗 HCC。对于不适合或对 TACE 无反应的中期 HCC 患者，治疗医生可能希望考虑其他治疗选择。通过将那些适合 TACE 的患者与那些可能几乎没有或没有受益的患者区分开来，也许可以更好地利用当前的治疗选择并改善患者的预后。
