Liver cancer is the sixth most common cancer worldwide in terms of the number of cases (626,000 or 5.7% of new cancer cases) but due to the very poor prognosis, the number of deaths is nearly similar (598,000). The survival rate is 3% to 5% in cancer registries for the United States and developing countries. The modality of treatment in hepatocellular carcinoma (HCC) patients depends on the stage of the disease. The Barcelona Clinic Liver Cancer Classification (BCLC) is the favorite staging system. There are many patients who initially present with the intermediate-stage disease, and in this setting transarterial chemoembolization (TACE) is the treatment of choice.
The purpose of this article is to highlight and discuss the role of chemoembolization in the treatment of hepatocellular carcinoma, including the results of recent large studies, and the concept of combined therapies, illustrating our case.
The differences in individual factors that are not captured by the BCLC framework, such as the tumor growth pattern, degree of hypervascularity, and vascular supply, complicate the further evaluation of these patients. Because of these differences, not all patients benefit equally from TACE. Several tools have been devised to aid the decision-making process which have shown promising initial results but have failed external evaluation and have not been translated to the clinical aspects. Criteria for treatment decisions in daily clinical practice are needed in all stages of the disease.
Conclusion: TACE is a safe method for prolonging patients' survival with unresectable HCC. The correct treatment of HCC is concentrated in cancer centers, and cooperation between multiple specialists is necessary.
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