Transarterial chemoembolization (TACE) is a first-line treatment for patients with hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer stage B (BCLC-B). There are two major techniques of TACE: conventional TACE (cTACE) using iodized oil and gelatin sponge particles, and TACE using drug-eluting beads (DEB-TACE). The latest randomized controlled trial proved the superiority of cTACE regarding local effects over DEB-TACE; however, cTACE also damages the liver more severely. Therefore, cTACE should be performed for localized HCCs as selectively as possible. On the other hand, DEB-TACE has less liver toxicity and is favorable for patients with an advanced age, large and/or bilobar tumors, or a poor liver function. However, some BCLC-B HCCs are TACE-resistant and the concept of TACE unsuitability (mainly up-to-7 criteria out) has been proposed by Asia-Pacific Primary Liver Cancer Expert Meeting. Systemic therapy is recommended for patients with TACE-unsuitable HCC; however, the condition of TACE-unsuitable HCC does not always rule out TACE monotherapy and some up-to-7 criteria out tumors may also be good candidates for superselective cTACE when localized in limited liver segments. The sequential therapy of an antiangiogenic and TACE is also a novel option for patients with TACE-unsuitable HCC, antiangiogenic-refractory HCC, or even down-staged HCC.

中文翻译：

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经肝动脉化疗栓塞治疗肝细胞癌的策略

经动脉化疗栓塞（TACE）是巴塞罗那C期肝癌（BCLC-B）肝细胞癌（HCC）患者的一线治疗。TACE有两种主要技术：使用碘化油和明胶海绵颗粒的常规TACE（cTACE），以及使用药物洗脱珠（DEB-TACE）的TACE。最新的随机对照试验证明了cTACE在局部效应方面优于DEB-TACE。但是，cTACE也会更严重地损害肝脏。因此，应尽可能有选择地对局部HCC执行cTACE。另一方面，DEB-TACE具有较低的肝毒性，对年龄较大，大和/或双叶肿瘤或肝功能较差的患者有利。然而，某些BCLC-B肝癌具有TACE耐药性，TACE不合适性的概念（主要是多达7条标准）已由亚太原发性肝癌专家会议提出。建议对TACE不适合的HCC患者进行全身治疗；然而，不适用于TACE的HCC并不总能排除TACE单一疗法的局限性，并且当肿瘤局限于局部肝段时，某些高达7个标准的肿瘤也可能是超选择性cTACE的良好候选者。对于不适合TACE的HCC，抗血管生成性难治性HCC甚至是降级HCC的患者，抗血管生成和TACE的序贯治疗也是一种新选择。TACE不适合的HCC的情况并不总是排除TACE单一疗法，并且当肿瘤局限于局部肝脏段时，某些高达7个标准的肿瘤也可能是超选择性cTACE的良好候选者。对于不适合TACE的HCC，抗血管生成难治性HCC或什至降级的HCC患者，抗血管生成和TACE的序贯治疗也是一种新选择。TACE不适合的HCC的情况并不总是排除TACE单一疗法，并且当肿瘤局限于局部肝脏段时，某些高达7个标准的肿瘤也可能是超选择性cTACE的良好候选者。对于不适合TACE的HCC，抗血管生成性难治性HCC甚至是降级HCC的患者，抗血管生成和TACE的序贯治疗也是一种新选择。