Abstract
Transcatheter arterial chemoembolization is the world standard therapy for unresectable HCC; however, standard methods are not unified, and several methods including DEB-TACE, B-TACE and cTACE have been used. Embolization concepts are different. Microspheres reach the micro tumor feeder inside or peripheral tumor level and spare the relatively large tumor feeder and do not reach the tumor sinus in DEB-TACE. Iodized oil filled with not only tumor sinus and micro tumor feeder but also peripheral tumor drainage vein and relatively large tumor feeder in B-TACE and cTACE. Tumor response is almost the same between the methods. DEB-TACE has a low rate of post TAE events, especially, abdominal pain, and also has only slight liver enzyme elevation. However, it needs a larger amount of contrast medium and long procedure time compared to B-TACE and cTACE. Elderly or patients who experienced a severe post TAE event are recommended DEB-TACE. Patients with renal insufficiency are recommended B-TACE or cTACE. B-TACE is an easy and effective methods. It exerts a good tumor response when arterio-arterial communication flows favorably. Confirmative angiography with balloon occlusion is necessary before B-TACE. In conclusion, good IVRists need the ability for handling DEB-TACE, B-TACE or cTACE.
