Cancer Treatment Reviews
Volume 37, Issue 3 , Pages 212-220 , May 2011

Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: Available evidence and expert opinion on the use of transarterial chemoembolization

  • J.-L. Raoul

      Affiliations

    • Department of Medical Oncology, Centre E. Marquis, INSERM U991 and Rennes University, CS4429, 35042 Rennes, France
    • Corresponding Author InformationCorresponding author. Tel.: +33 299253196; fax: +33 299253108.
    • ,
  • B. Sangro

      Affiliations

    • Liver Unit, Clinica Universitaria de Navarra, Pamplona 31008, Spain
    • Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Avenida Pio XII, 36, Pamplona 31008, Spain
    • ,
  • A. Forner

      Affiliations

    • Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
    • ,
  • V. Mazzaferro

      Affiliations

    • National Cancer Institute, IRCCS Foundation, Via Venezian 1, 20133 Milan, Italy
    • ,
  • F. Piscaglia

      Affiliations

    • Department of Digestive Disease and Internal Medicine, S. Orsola – Malpighi General and University Hospital, Via Albertoni 15, Bologna 40138, Italy
    • ,
  • L. Bolondi

      Affiliations

    • Department of Digestive Disease and Internal Medicine, S. Orsola – Malpighi General and University Hospital, Via Albertoni 15, Bologna 40138, Italy
    • ,
  • R. Lencioni

      Affiliations

    • Pisa University School of Medicine, Cisanello Hospital, Building No. 30C, Suite 197, Via Paradisa 2, IT 56124 Pisa, Italy

Received 4 May 2010 ,Accepted 19 July 2010.

References 

  1. Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108
  2. Berrino F, De AR, Sant M, et al. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995–99: results of the EUROCARE-4 study. Lancet Oncol. 2007;8:773–783
  3. Verdecchia A, Francisci S, Brenner H, et al. Recent cancer survival in Europe: a 2000–02 period analysis of EUROCARE-4 data. Lancet Oncol. 2007;8:784–796
  4. Okuda K, Ohtsuki T, Obata H, et al. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer. 1985;56:918–928
  5. Sobin L, Wittekind C. International union against cancer: TMN classification of malignant tumours. 6th ed.. New York: Wiley-Liss; 2007;
  6. The Cancer of the Liver Italian Program (CLIP) investigation. Prospective validation of the CLIP score: a new prognostic system for patients with cirrhosis and hepatocellular carcinoma. Hepatolgy 2000;31:840–5.
  7. Kudo M, Chung H, Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol. 2003;38:207–215
  8. Leung TW, Tang AM, Zee B, et al. Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system: a study based on 926 patients. Cancer. 2002;94:1760–1769
  9. Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19:329–338
  10. Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001;35:421–430
  11. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208–1236
  12. Llovet JM, Di Bisceglie AM, Bruix J, et al. Design and endpoints of clinical trials in hepatocellular carcinoma. J Natl Cancer Inst. 2008;100:698–711
  13. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology. 2003;37:429–442
  14. Llovet JM, Real MI, Montana X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002;359:1734–1739
  15. Lo CM, Ngan H, Tso WK, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002;35:1164–1171
  16. A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma. Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire. New Engl J Med 1995;332:1256–61.
  17. Bruix J, Llovet JM, Castells A, et al. Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology. 1998;27:1578–1583
  18. Lin DY, Liaw YF, Lee TY, et al. Hepatic arterial embolization in patients with unresectable hepatocellular carcinoma – a randomized controlled trial. Gastroenterology. 1988;94:453–456
  19. Pelletier G, Ducreux M, Gay F, et al. Treatment of unresectable hepatocellular carcinoma with lipiodol chemoembolization: a multicenter randomized trial. Groupe CHC. J Hepatol. 1998;29:129–134
  20. Doffoel M, Bonnetain F, Bouche O, et al. Multicentre randomised phase III trial comparing tamoxifen alone or with transarterial lipiodol chemoembolisation for unresectable hepatocellular carcinoma in cirrhotic patients (Federation Francophone de Cancerologie Digestive 9402). Eur J Cancer. 2008;44:528–538
  21. Camma C, Schepis F, Orlando A, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology. 2002;224:47–54
  22. Lopez RR, Pan SH, Hoffman AL, et al. Comparison of transarterial chemoembolization in patients with unresectable, diffuse vs focal hepatocellular carcinoma. Arch Surg. 2002;137:653–657
  23. Yuen MF, Chan AO, Wong BC, et al. Transarterial chemoembolization for inoperable, early stage hepatocellular carcinoma in patients with Child-Pugh grade A and B: results of a comparative study in 96 Chinese patients. Am J Gastroenterol. 2003;98:1181–1185
  24. Kothary N, Weintraub JL, Susman J, et al. Transarterial chemoembolization for primary hepatocellular carcinoma in patients at high risk. J Vasc Interv Radiol. 2007;18:1517–1526
  25. Telesca C, Angelico M, Petrolati A, et al. Early-stage hepatocellular carcinoma: complete ablation predict survival in cirrhotic patients treated by laser ablation (la) combined with selective chemoembolization (sTACE). Hepatology [AASLD Abstracts]. 2008;48(S1):960A;[abstract 1468]
  26. Huo T, Huang YH, Wu JC, et al. Comparison of transarterial chemoembolization and percutaneous acetic acid injection as the primary loco-regional therapy for unresectable hepatocellular carcinoma: a prospective survey. Aliment Pharmacol Ther. 2004;19:1301–1308
  27. Ebied OM, Federle MP, Carr BI, et al. Evaluation of responses to chemoembolization in patients with unresectable hepatocellular carcinoma. Cancer. 2003;97:1042–1050
  28. Gunji T, Kawauchi N, Akahane M, et al. Long-term outcomes of transcatheter arterial chemoembolization with autologous blood clot for unresectable hepatocellular carcinoma. Int J Oncol. 2002;21:427–432
  29. El-Serag HB, Marrero JA, Rudolph L, et al. Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology. 2008;134:1752–1763
  30. Herber SC, Otto G, Schneider J, et al. Transarterial chemoembolization in patients not eligible for liver transplantation: single-center results. AJR Am J Roentgenol. 2008;190:1035–1042
  31. Cho YK, Chung JW, Kim JK, et al. Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Cancer. 2008;112:352–361
  32. Kirchhoff TD, Bleck JS, Dettmer A, et al. Transarterial chemoembolization using degradable starch microspheres and iodized oil in the treatment of advanced hepatocellular carcinoma: evaluation of tumor response, toxicity, and survival. Hepatobiliary Pancreat Dis Int. 2007;6:259–266
  33. Takayasu K, Arii S, Ikai I, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology. 2006;131:461–469
  34. Huang YH, Wu JC, Chen SC, et al. Survival benefit of transcatheter arterial chemoembolization in patients with hepatocellular carcinoma larger than 10cm in diameter. Aliment Pharmacol Ther. 2006;23:129–135
  35. Dumortier J, Chapuis F, Borson O, et al. Unresectable hepatocellular carcinoma: survival and prognostic factors after lipiodol chemoembolisation in 89 patients. Dig Liver Dis. 2006;38:125–133
  36. Jansen MC, van HR, Chamuleau RA, et al. Outcome of regional and local ablative therapies for hepatocellular carcinoma: a collective review. Eur J Surg Oncol. 2005;31:331–347
  37. Bruix J, Sala M, Llovet JM. Chemoembolization for hepatocellular carcinoma. Gastroenterology. 2004;127:S179–S188
  38. Li X, Feng GS, Zheng CS, et al. Expression of plasma vascular endothelial growth factor in patients with hepatocellular carcinoma and effect of transcatheter arterial chemoembolization therapy on plasma vascular endothelial growth factor level. World J Gastroenterol. 2004;10:2878–2882
  39. Guo WJ, Yu EX, Liu LM, et al. Comparison between chemoembolization combined with radiotherapy and chemoembolization alone for large hepatocellular carcinoma. World J Gastroenterol. 2003;9:1697–1701
  40. Yamada K, Izaki K, Sugimoto K, et al. Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2003;57:113–119
  41. Testa R, Testa E, Giannini E, et al. Trans-catheter arterial chemoembolisation for hepatocellular carcinoma in patients with viral cirrhosis: role of combined staging systems, Cancer Liver Italian Program (CLIP) and Model for End-stage Liver Disease (MELD), in predicting outcome after treatment. Aliment Pharmacol Ther. 2003;17:1563–1569
  42. Grieco A, Marcoccia S, Miele L, et al. Transarterial chemoembolization (TACE) for unresectable hepatocellular carcinoma in cirrhotics: functional hepatic reserve and survival. Hepatogastroenterology. 2003;50:207–212
  43. O’Suilleabhain CB, Poon RT, Yong JL, et al. Factors predictive of 5-year survival after transarterial chemoembolization for inoperable hepatocellular carcinoma. Brit J Surg. 2003;90:325–331
  44. Katyal S, Oliver JH, Peterson MS, et al. Prognostic significance of arterial phase CT for prediction of response to transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma: a retrospective analysis. AJR Am J Roentgenol. 2000;175:1665–1672
  45. Kwok PC, Lam TW, Chan SC, et al. A randomized clinical trial comparing autologous blood clot and gelfoam in transarterial chemoembolization for inoperable hepatocellular carcinoma. J Hepatol. 2000;32:955–964
  46. Ueno K, Miyazono N, Inoue H, et al. Transcatheter arterial chemoembolization therapy using iodized oil for patients with unresectable hepatocellular carcinoma: evaluation of three kinds of regimens and analysis of prognostic factors. Cancer. 2000;88:1574–1581
  47. Vogl TJ, Trapp M, Schroeder H, et al. Transarterial chemoembolization for hepatocellular carcinoma: volumetric and morphologic CT criteria for assessment of prognosis and therapeutic success–results from a liver transplantation center. Radiology. 2000;214:349–357
  48. Ernst O, Sergent G, Mizrahi D, et al. Treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization: comparison of planned periodic chemoembolization and chemoembolization based on tumor response. AJR Am J Roentgenol. 1999;172:59–64
  49. Kawai S, Tani M, Okamura J, et al. Prospective and randomized trial of lipiodol-transcatheter arterial chemoembolization for treatment of hepatocellular carcinoma: a comparison of epirubicin and doxorubicin (second cooperative study). The Cooperative Study Group for Liver Cancer Treatment of Japan. Semin Oncol. 1997;24:S6
  50. Florio F, Nardella M, Balzano S, et al. Treatment of hepatocellular carcinoma: a single-center experience. Cardiovasc Intervent Radiol. 1997;20:23–28
  51. Farinati F, De MN, Marafin C, et al. Unresectable hepatocellular carcinoma in cirrhosis: survival, prognostic factors, and unexpected side effects after transcatheter arterial chemoembolization. Dig Dis Sci. 1996;41:2332–2339
  52. Malaguarnera M, Trovato G, Restuccia S, et al. Treatment of nonresectable hepatocellular carcinoma: review of the literature and meta-analysis. Adv Ther. 1994;11:303–319
  53. Bronowicki JP, Vetter D, Dumas F, et al. Transcatheter oily chemoembolization for hepatocellular carcinoma. A 4-year study of 127 French patients. Cancer. 1994;74:16–24
  54. Mondazzi L, Bottelli R, Brambilla G, et al. Transarterial oily chemoembolization for the treatment of hepatocellular carcinoma: a multivariate analysis of prognostic factors. Hepatology. 1994;19:1115–1123
  55. Stuart K, Stokes K, Jenkins R, et al. Treatment of hepatocellular carcinoma using doxorubicin/ethiodized oil/gelatin powder chemoembolization. Cancer. 1993;72:3202–3209
  56. Gunji T, Kawauchi N, Ohnishi S, et al. Treatment of hepatocellular carcinoma associated with advanced cirrhosis by transcatheter arterial chemoembolization using autologous blood clot: a preliminary report. Hepatology. 1992;15:252–257
  57. Yang CF, Ho YJ. Transcatheter arterial chemoembolization for hepatocellular carcinoma. Cancer Chemother Pharmacol. 1992;31(Suppl.):S86–S88
  58. Hsieh MY, Chang WY, Wang LY, et al. Treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization and analysis of prognostic factors. Cancer Chemother Pharmacol. 1992;31(Suppl.):S82–S85
  59. Bruix J, Castells A, Montanya X, et al. Phase II study of transarterial embolization in European patients with hepatocellular carcinoma: need for controlled trials. Hepatology. 1994;20:643–650
  60. Lencioni R, Malagari K, Vogl T, et al. A randomized phase II trial of a drug eluting bead in the treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization. In: Abstract 116 presented at the ASCO gastrointestinal cancers symposium, San Francisco, CA, USA; 15–17 January 2009.
  61. Horiguchi Y, Itoh M, Takawaga H, et al. Assessment of chemoembolization therapy for primary liver cancer using a stabilized adriamycin-lipiodol suspension. Cancer Chemother Pharmacol. 1992;31:S60–S64
  62. Farinati F, Giacomin A, Tartaro P, et al. Intermediate stage HCC: to TACE or not to TACE?. J Hepatol [Abstracts of the International Liver Congress 2009]. 2009;50(Suppl. 1):S288–S289[abstract 788]
  63. Doan PL, O’Neil BH, Moore DT, et al. Predictors of survival in patients with hepatocellular carcinoma treated with transarterial chemoembolization. J Clin Oncol ASCO Annu Meet Proc. 2008;26(15S):15522
  64. Hanks BA, Suhocki PV, DeLong DM, et al. The efficacy and tolerability of transarterial chemo-embolization (TACE) compared with transarterial embolization (TAE) for patients with unresectable hepatocellular carcinoma (HCC). J Clin Oncol ASCO Annu Meet Proc. 2008;26(15S):4595
  65. Lee HS, Kim JS, Choi IJ, et al. The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction. A prospective controlled study. Cancer. 1997;79:2087–2094
  66. Lammer J, Malagari K, Vogl T, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol. 2010;33:41–52
  67. Shim JH, Park JW, Kim JH, et al. Association between increment of serum VEGF level and prognosis after transcatheter arterial chemoembolization in hepatocellular carcinoma patients. Cancer Sci. 2008;99:2037–2044
  68. Sergio A, Cristofori C, Cardin R, et al. Transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC): the role of angiogenesis and invasiveness. Am J Gastroenterol. 2008;103:914–921
  69. Okada Y, Ina H, Kubota K, et al. Computed tomography-guided transarterial chemoembolization as the initial therapy for hepatocellular carcinoma: experience of 75 cases in a single institute. Dig Dis Sci. 2003;48:587–593
  70. Saccheri S, Lovaria A, Sangiovanni A, et al. Segmental transcatheter arterial chemoembolization treatment in patients with cirrhosis and inoperable hepatocellular carcinomas. J Vasc Interv Radiol. 2002;13:995–999
  71. Poon RT, Ngan H, Lo CM, et al. Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence. J Surg Oncol. 2000;73:109–114
  72. Savastano S, Miotto D, Casarrubea G, et al. Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with child’s grade A or B cirrhosis: a multivariate analysis of prognostic factors. J Clin Gastroenterol. 1999;28:334–340
  73. Jaeger HJ, Mehring UM, Castaneda F, et al. Sequential transarterial chemoembolization for unresectable advanced hepatocellular carcinoma. Cardiovasc Intervent Radiol. 1996;19:388–396
  74. Shah SR, Riordan SM, Karani J, et al. Tumour ablation and hepatic decompensation rates in multi-agent chemoembolization of hepatocellular carcinoma. QJM. 1998;91:821–828
  75. Poon RT, Lau C, Yu WC, et al. High serum levels of vascular endothelial growth factor predict poor response to transarterial chemoembolization in hepatocellular carcinoma: a prospective study. Oncol Rep. 2004;11:1077–1084
  76. Bayraktar Y, Balkanci F, Kayhan B, et al. A comparison of chemoembolization with conventional chemotherapy and symptomatic treatment in cirrhotic patients with hepatocellular carcinoma. Hepatogastroenterology. 1996;43:681–687
  77. Ahrar K, Gupta S. Hepatic artery embolization for hepatocellular carcinoma: technique, patient selection, and outcomes. Surg Oncol Clin N Am. 2003;12:105–126
  78. Chung JW, Park JH, Han JK, et al. Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology. 1996;198:33–40
  79. Chan AO, Yuen MF, Hui CK, et al. A prospective study regarding the complications of transcatheter intraarterial lipiodol chemoembolization in patients with hepatocellular carcinoma. Cancer. 2002;94:1747–1752
  80. Chen MS, Li JQ, Zhang YQ, et al. High-dose iodized oil transcatheter arterial chemoembolization for patients with large hepatocellular carcinoma. World J Gastroenterol. 2002;8:74–78
  81. Hwang JI, Chow WK, Hung SW, et al. Development of a safety index of transarterial chemoembolization for hepatocellular carcinoma to prevent acute liver damage. Anticancer Res. 2005;25:2551–2554
  82. Forner A, Ayuso C, Varela M, et al. Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma: are response evaluation criteria in solid tumors reliable?. Cancer. 2009;115:616–623
  83. Greten TF, Papendorf F, Bleck JS, et al. Survival rate in patients with hepatocellular carcinoma: a retrospective analysis of 389 patients. Brit J Cancer. 2005;92:1862–1868
  84. Hsieh CB, Chang HM, Chen TW, et al. Comparison of transcatheter arterial chemoembolization, laparoscopic radiofrequency ablation, and conservative treatment for decompensated cirrhotic patients with hepatocellular carcinoma. World J Gastroenterol. 2004;10:505–508
  85. Kagawa T, Kojima T, Numata M, et al. Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for with hepatocellular carcinoma – comparison with surgical resection. Hepatology [AASLD Abstracts]. 2008;48(S1):498A;[abstract 426]
  86. Kim JH, Jung YK, Choi JH, et al. Transarterial chemoembolization could achieved a survival benefit in selected patients who have advanced stage of hepatocellular carcinoma. Hepatology [AASLD Abstracts]. 2008;48(S1):962A;[abstract 1474]
  87. Llado L, Virgili J, Figueras J, et al. A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization. Cancer. 2000;88:50–57
  88. Pelletier G, Roche A, Ink O, et al. A randomized trial of hepatic arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Hepatol. 1990;11:181–184
  89. Rougier P, Roche A, Pelletier G, et al. Efficacy of chemoembolization for hepatocellular carcinomas: experience from the Gustave Roussy Institute and the Bicetre Hospital. J Surg Oncol Suppl. 1993;3:94–96
  90. Shen H, Agarwal D, Qi R, et al. Predictors of outcome in patients with unresectable hepatocellular carcinoma receiving transcatheter arterial chemoembolization. Aliment Pharmacol Ther. 2007;26:393–400
  91. Takayasu K, Muramatsu Y, Maeda T, et al. Targeted transarterial oily chemoembolization for small foci of hepatocellular carcinoma using a unified helical CT and angiography system: analysis of factors affecting local recurrence and survival rates. AJR Am J Roentgenol. 2001;176:681–688
  92. Watanabe S, Nishioka M, Ohta Y, et al. Prospective and randomized controlled study of chemoembolization therapy in patients with advanced hepatocellular carcinoma. Cooperative Study Group for Liver Cancer Treatment in Shikoku area. Cancer Chemother Pharmacol. 1994;33(Suppl.):S93–S96
  93. Acunas B, Rozanes I. Hepatocellular carcinoma: treatment with transcatheter arterial chemoembolization. Eur J Radiol. 1999;32:86–89
  94. Befeler AS. Chemoembolization and bland embolization: a critical appraisal. Clin Liver Dis. 2005;9:287–300
  95. Pleguezuelo M, Germani G, Marelli L, et al. Evidence-based diagnosis and locoregional therapy for hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol. 2008;2:761–784
  96. Pleguezuelo M, Marelli L, Misseri M, et al. TACE versus TAE as therapy for hepatocellular carcinoma. Expert Rev Anticancer Ther. 2008;8:1623–1641
  97. Sikander A, Sadashiv S, Ronald S, et al. Transarterial chemoembolization in a patient with recurrent hepatocellular carcinoma and portal vein thrombosis: a case report and review of the literature. Am J Clin Oncol. 2005;28:638–639
  98. Kettenbach J, Stadler A, Katzler IV, et al. Drug-loaded microspheres for the treatment of liver cancer: review of current results. Cardiovasc Intervent Radiol. 2008;31:468–476
  99. Lau WY, Yu SC, Lai EC, et al. Transarterial chemoembolization for hepatocellular carcinoma. J Am Coll Surg. 2006;202:155–168
  100. Monna T, Kanno T, Marumo T, et al. A comparison of transcatheter arterial embolization with one shot therapy for the patients with hepatic cell carcinoma. Gastroenterol Jpn. 1982;17:542–549
  101. Ikeda K, Kumada H, Saitoh S, et al. Effect of repeated transcatheter arterial embolization on the survival time in patients with hepatocellular carcinoma. An analysis by the Cox proportional hazard model. Cancer. 1991;68:2150–2154
  102. Lu W, Li Y, He X, et al. Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with cirrhosis: evaluation of two kinds of dosages of anticancer drugs and analysis of prognostic factors. Hepatogastroenterology. 2003;50:2079–2083
  103. Parikh P, Malhotra H, Jelic S. Hepatocellular carcinoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2008;19(Suppl. 2):ii27–ii28
  104. Ryder SD. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults. Gut. 2003;52(Suppl. 3):iii1–iii8
  105. Bartolozzi C, Lencioni R, Caramella D, et al. Treatment of large HCC: transcatheter arterial chemoembolization combined with percutaneous ethanol injection versus repeated transcatheter arterial chemoembolization. Radiology. 1995;197:812–818
  106. Venook AP, Stagg RJ, Lewis BJ, et al. Chemoembolization for hepatocellular carcinoma. J Clin Oncol. 1990;8:1108–1114
  107. Bruix J, Raoul JL, Sherman M, et al. Efficacy and safety of sorafenib in patients with hepatocellular carcinoma (HCC): Subanalysis of sharp trial based on Barcelona clinic liver cancer (BCLC) stage. J Hepatol. 2009;50:S28–S29
  108. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers v2.2009. Available at: www.nccn.org [accessed April 2009].
  109. Forner A, Ayuso C, Isabel RM, et al. Diagnosis and treatment of hepatocellular carcinoma. Med Clin (Barc). 2009;132:272–287
  110. Barone M, Ettorre GC, Ladisa R, et al. Transcatheter arterial chemoembolization (TACE) in treatment of hepatocellular carcinoma. Hepatogastroenterology. 2003;50:183–187
  111. Lencioni R, Llovet J. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30:52–60

PII: S0305-7372(10)00131-3

doi: 10.1016/j.ctrv.2010.07.006

Cancer Treatment Reviews
Volume 37, Issue 3 , Pages 212-220 , May 2011

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