Enhancing global hepatocellular carcinoma management: Bridging Eastern and Western perspectives on dexamethasone and N-acetylcysteine before transarterial chemoembolization

Figure 1 Comparison between conventional transarterial chemoembolization, conventional transarterial chemoembolization with dexamethasone prophylaxis, and drug-eluting bead transarterial chemoembolization. The cost of treatment with conventional transarterial chemoembolization (cTACE) and drug-eluting bead TACE (DEB-TACE) is not significantly different; However, DEB-TACE is generally more expensive. The use of cTACE, with or without prophylactic dexamethasone (DEXA), reduces the risk of vascular damage in the liver more effectively than DEB-TACE, which is associated with the chemotherapeutic agent doxorubicin. The systemic toxicity of cTACE is higher compared to DEB-TACE; however, hepatic toxicity is lower with cTACE. The use of DEXA for prophylaxis further reduces liver damage due to inflammation. DEB-TACE has the advantage of drug release and maintenance, which is a significant benefit that cTACE lacks, leading to higher agreement on the use of DEB-TACE. The efficacy of the two methods in treating tumors varies based on size, with DEB-TACE showing better treatment outcomes for tumors larger than 5 cm. However, for tumors smaller than 2 cm, the effectiveness may not be clear and could even be lower for DEB-TACE compared to cTACE. The ability to prevent post-embolization syndrome (PES) is higher with DEB-TACE. Similarly, cTACE can effectively prevent PES when prophylaxed with DEXA. NA: Not available; DEB-TACE: Drug-eluting bead transarterial chemoembolization; cTACE: Conventional transarterial chemoembolization; DEXA: Dexamethasone.

Figure 2 Differences in treatment perspectives. A: Drug-eluting bead transarterial chemoembolization (TACE) is more favored in Western countries; B: Conventional transarterial chemoembolization is more favored in Eastern countries.; C: Describe the common causes of liver disease in the Western and Eastern regions, where the group of causes for liver disease in the West includes hepatitis C virus, alcohol-related liver disease, and metabolic-related liver disease, while in the East it includes viral hepatitis in general, use of hepatotoxic drugs, and alcohol consumption; D: Indications for TACE treatment in liver cancer patients. DEB-TACE: Drug-eluting bead transarterial chemoembolization; cTACE: Conventional transarterial chemoembolization.