Transarterial chemoembolization failure/refractoriness: A scientific concept or pseudo-proposition

Abstract

Multi-session transarterial chemoembolization (TACE) is usually needed for the treatment of intermediate-stage hepatocellular carcinoma (HCC), but it may not always have a positive influence on prognosis due to high heterogeneity of HCC. To avoid ineffective repeated TACE, the concept of TACE failure/refractoriness has been proposed by several organizations and is being addressed using tyrosine kinase inhibitors. The concept of TACE failure/refractoriness is controversial due to ambiguous definitions and low evidence-based data. To date, only a few studies have examined the rationality concerning the definition of TACE failure/refractoriness, although the concept has been introduced and applied in many TACE-related clinical trials. This review focuses on some of the issues related to different versions of TACE failure/refractoriness, the rationality of related definitions, and the feasibility of continuing TACE after so-called failure/refractoriness based on published evidence. A suggestion to re-define TAEC failure/refractoriness is also put forward.

Keywords: Hepatocellular carcinoma; Transarterial chemoembolization; Failure; Refractoriness

Core Tip: The definitions in the current concept of transarterial chemoembolization (TACE) failure/refractoriness are not capable of guiding clinical practice. A persistent viable tumor lesion is a well-accepted item of TACE failure/refractoriness, but that is not the case when it comes to new lesions, portal vein tumor thrombosis or extrahepatic spread. Patients with recurrent hepatocellular carcinoma after TACE constitute a heterogenous group and the treatment modalities need to be individualized.