Current Strategies to Identify Patients That Will Benefit from TACE Treatment and Future Directions a Practical Step-by-Step Guide

Abstract

Lukas Müller,1,* Fabian Stoehr,1,* Aline Mähringer-Kunz,1 Felix Hahn,1 Arndt Weinmann,2 Roman Kloeckner1 1Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany; 2Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany*These authors contributed equally to this work.Correspondence: Roman KloecknerDepartment of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, Mainz, 55131, GermanyTel [phone]Email [email protected]: Treatment of hepatocellular carcinoma (HCC) depends on the stage of disease. In the Western Hemisphere, the Barcelona Clinic Liver Cancer classification (BCLC) is the preferred staging system. Approximately one-third of patients initially present with intermediate-stage disease. For these patients, transarterial chemoembolization (TACE) is the treatment of choice. However, the intermediate-stage comprises a heterogeneous subgroup of patients with considerable differences in tumor burden and liver function. In addition, 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 further evaluation of these patients. Due to these differences, not all patients benefit equally from TACE. Several tools and scoring systems have been devised to provide decision-making support. All of these have shown promising initial results but failed external evaluation and have not been translated to the clinic. Nevertheless, criteria for objectifying treatment decisions in daily clinical practice are needed in all stages of disease. Therefore, this review provides a concise practical step-by-step guide on current strategies for patient selection and decision-making, with a focus on TACE, to critically evaluate the existing decision-support tools and provide a summary of the latest updates in the field.Keywords: hepatocellular carcinoma, transarterial chemoembolization, survival prediction, treatment decision support, practical step-by-step guide

Keywords

• hepatocellular carcinoma transarterial chemoembolization survival prediction treatment decision support practical step-by-step guide