The Use of Transcatheter Arterial Embolization and Systemic Therapyfor the Treatment of Hepatocellular Carcinoma

Abstract

The treatment of hepatocellular carcinoma (HCC) is based on the tumors’ condition and the liver reserve capacity. This article describes transcatheter arterial embolization (TAE) and systemic therapy, which is mainly used aspalliative therapy. TAE is widely used for conditions that cannot be curatively treated. We mainly used Lipiodol,an anticancer drug (mainly cisplatin and epirubicin) and a gelatin sponge. The procedure was performed on 832patients over the course of 16 years, from 2001 to 2016. The median survival time (MST) was I: 49 months, II:35 months, III: 24 months, and IV: 11 months for each stage. Recently, a permanent embolic material was used totreat a large HCC that measured at least 5 cm, and the survival period was extended. The MST was 24.3 monthsafter using a permanent embolic material 9.3 months before the procedure (P = 0.013). However, the incidenceof HCC is decreasing due to the decrease in HCV infection, so the number of TAE procedures is also decreasing. Molecularly-targeted therapy for HCC have been available since 2009, and several types of drugs have beendiscovered since then. Recent progress is especially remarkable. Systemic therapy was originally used to treatcases in which the efficacy of TAE was diminished or ineffective. Today, new attempts are being made to improvethe effectiveness of combination treatments, such as TAE, radiofrequency ablation and resection. At present, thefirst-line treatment of HCC is atezolizumab + bevacizumab combination therapy. The second-line treatment issorafenib and lenvatinib. Other drugs, such as ramucirumab (AFP ≥ 400 ng/mL), cabozantinib, and regorafenib,can also be used. Systemic therapy has made remarkable progress recently and is expected to improve the survivalof HCC.