Results and Limitations of TACE for Intermediate Stage HCC

Due to the development of new molecular targeted agents (MTAs) and immune checkpoint inhibitors (ICIs), the treatment strategy for intermediate stage HCC is changing. To clarify the indications for TACE, MTAs/ICIs, or combination therapy, it is necessary to show the results and limitations of TACE for intermediate stage HCC. The Asia-Pacific Primary Liver Cancer Expert Consensus Statement suggested that “beyond up-to-7 criteria” was unsuitable for TACE. However, in clinical practice, the criteria to determine the contraindications to TACE are still controversial. Our data demonstrated that tumor number ≥ 11 was the significant factor. In addition, from Asian countries, up-to-11 criteria and 7-11 criteria, which would replace the up-to-7 criteria, were reported. Achievement of complete response (CR) by TACE can prolong overall survival. Our recent analysis of TACE for beyond up-to-7 criteria cases demonstrated that 57% of patients achieved CR. The significant factor related to CR was up-to-11 criteria. TACE techniques are important to improve efficacy. The 3D-safety-margin is one of the important factors to obtain curability. Current TACE navigation using angio-CT or cone-beam CT is useful to identify the tumor feeding artery. Development of tiny microcatheters and guidewires is also important for superselective TACE. In addition, the recently developed pumping emulsification device with a microporous glass membrane could increase the antitumor effect of selective cTACE.