Are there papers on transcatheter arterial chemoembolization of hepatocellular carcinoma?
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Transcatheter Arterial Chemoembolization (TACE) for Hepatocellular Carcinoma: A Comprehensive Review
Introduction to TACE in Hepatocellular Carcinoma Treatment
Hepatocellular carcinoma (HCC) is a prevalent form of liver cancer with a high mortality rate, often diagnosed at intermediate to advanced stages where surgical options are limited. Transcatheter arterial chemoembolization (TACE) has emerged as a first-line therapy for unresectable HCC, offering a targeted approach to deliver chemotherapy directly to the tumor while obstructing its blood supply .
Efficacy of TACE Plus Radiotherapy
Recent studies have explored the combination of TACE with radiotherapy (RT) to enhance therapeutic outcomes. A meta-analysis comparing TACE plus RT to TACE alone demonstrated significantly improved survival rates and tumor response in patients receiving the combined treatment. Specifically, the 1-year survival odds ratio (OR) was 1.36, with progressive increases in survival benefits observed over 2 to 5 years. Another systematic review corroborated these findings, highlighting the enhanced efficacy and safety profile of TACE plus RT, although it noted the need for further randomized controlled trials to solidify these results.
TACE with Drug-Eluting Beads vs. Conventional TACE
The use of drug-eluting beads in TACE (DEB-TACE) has been compared to conventional TACE (C-TACE) in several studies. DEB-TACE has shown non-inferiority to C-TACE, with better objective response and disease control rates, and fewer severe complications and all-cause mortality. This suggests that DEB-TACE could be a preferable option for managing unresectable HCC due to its improved safety and efficacy profile.
Innovative Approaches: Arsenic Trioxide and High-Intensity Focused Ultrasound
Innovative approaches to TACE include the use of CalliSpheres beads loaded with arsenic trioxide (CBATO-TACE) and the combination of TACE with high-intensity focused ultrasound (HIFU). CBATO-TACE has demonstrated superior progression-free survival (PFS) and overall survival (OS) compared to conventional TACE, with fewer treatment-related adverse events. Similarly, TACE combined with HIFU has shown increased overall survival and tumor response rates in intermediate and advanced HCC, suggesting a promising adjunctive therapy .
Role of Cone-Beam CT in TACE
Cone-beam computed tomography (CBCT) has been identified as a valuable tool in enhancing the efficacy of TACE. CBCT significantly improves the detection of tumors and their feeding arteries compared to digital subtraction angiography (DSA), with pooled sensitivities of 90% and 93% respectively. This increased detection capability can lead to more precise and effective TACE procedures.
Adjuvant TACE Post-Hepatectomy
Adjuvant TACE following curative resection for HCC patients with solitary tumors and microvascular invasion (MVI) has been shown to improve disease-free survival (DFS) and overall survival (OS). A randomized clinical trial reported significantly longer median DFS and OS in patients receiving adjuvant TACE compared to those undergoing hepatectomy alone. A systematic review further supported these findings, indicating that adjuvant TACE is particularly beneficial for patients with multinodular HCC, MVI, or portal vein tumor thrombosis (PVTT).
TACE vs. Transcatheter Arterial Chemotherapy Infusion (TACI)
Comparative studies between TACE and transcatheter arterial chemotherapy infusion (TACI) have shown that TACE is associated with better survival outcomes and higher response rates. TACE was linked to a 23% lower hazard of death and a significantly higher objective response rate compared to TACI, making it a more favorable option for patients with intermediate or advanced HCC.
Conclusion
Transcatheter arterial chemoembolization (TACE) remains a cornerstone in the management of unresectable hepatocellular carcinoma. Advances in combination therapies, innovative drug delivery systems, and imaging techniques continue to enhance its efficacy and safety. Future research should focus on optimizing these approaches and conducting further randomized controlled trials to establish standardized treatment protocols.
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