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Digestive Disease Interventions 2024; 08(01): 52-81
DOI: 10.1055/s-0043-1772742
Review Article

Bland Embolization and Transarterial Chemoembolization in Hepatocarcinoma

Alfonso Jose Holguín Holguín
1   Department of Diagnostic Imaging, Fundación Valle del Lili, ICESI University, Cali, Valle del Cauca, Colombia
,
Juan Sebastián Toro Gutierrez
1   Department of Diagnostic Imaging, Fundación Valle del Lili, ICESI University, Cali, Valle del Cauca, Colombia
,
Luis Alfonso Bustamante-Cristancho
2   Department of Critical Care Medicine, Clínica Imbanaco, Pontificia Universidad Javeriana Cali, Cali, Valle del Cauca, Colombia
,
Tatiana Alvarez Saa
3   Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Valle del Cauca, Colombia
,
Juan C. Camacho
4   Vascular and Interventional Radiology, Florida State University, Sarasota, Florida, Florida
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Abstract

Hepatocarcinoma (HCC) is the main cause of morbidity and mortality worldwide in patients with cirrhosis. Eighty percent of cases worldwide are due to infections with hepatitis B and C viruses, but nonalcoholic steatohepatitis (NASH) is projected to be an important etiology. It is usually diagnosed in advanced stages, only 15% of patients are surgical candidates, and up to 35% can receive only supportive care. This pathology has changed over time with the significant advances in treatment alternatives that can improve life expectancy for patients who are not surgical candidates. Therapeutic alternatives are available based on staging according to different models and the Barcelona Clinic Liver Cancer (BCLC) staging system. Systemic pharmacological options (neoadjuvant, adjuvant, and hormonal therapy), surgical options, and locoregional therapies have been developed; all these interventions have been directed to increase the life expectancy of some patients with variable results. Regional therapies include transarterial embolization (TAE) or bland embolization, transarterial infusion chemotherapy, conventional transarterial chemoembolization (TACE), drug-eluting bead transarterial chemoembolization (DEB-TACE), and transarterial radioembolization, with no substantial difference in outcomes between patients treated with TACE and those receiving DEB-TACE, but benefits of lower systemic adverse effects and improved of quality-adjusted life years measure with DEB-TACE. With the addition of immunotherapy to these interventions, the outcomes are expected to be even more impactful on main outcomes such as survival and disease-free survival.

Keywords

hepatocellular carcinoma - therapeutic embolization - intra-arterial injections - hepatic cirrhosis - sorafenib


Publication History

Received: 28 March 2023

Accepted: 11 July 2023

Article published online:
04 October 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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