TAE for HCC: When the Old Way is Better than the New Ones!!!

Excerpt

Transarterial chemoembolization (TACE) is nowadays widely applied as a treatment for hepatocellular carcinomas (HCCs) that are not suitable for percutaneous ablation or surgical resection, as this technique has been demonstrated to improve survival in comparison with best supportive care [1]. However, it is still unclear whether results of this kind of treatment are more related to the ischemic effect of the embolization or to the local effect of the delivered drug. In fact, no evidence of superiority of TACE in comparison with embolization alone (TAE) has been ever demonstrated—even if embolizing materials in conventional TACE were not designed to achieve the best ischemic effect, but only to temporarily stop the blood flow to increase the local effect of the drug [2]. Moreover, up to now, there are no drugs with proven good efficacy over HCC, and doxorubicin, the most widely used agent, has been proven to determine only marginal benefits for the patients in terms of disease control and survival [3]. Conversely, doxorubicin has been shown to determine liver toxicity, with a potential consequent worsening of liver function, which might be particularly relevant in cirrhotic patients [4]. Following the idea that the ischemic effect is the most important one in the transarterial treatment of HCC, some materials with higher embolizing effect have been developed and more precise superselective embolizing techniques have been adopted [5, 6]. In particular, the adoption of very small caliber particles, which could reach smaller peripheral arteries causing permanent ischemia, has been reported with favorable results. …