Transient Cytolysis after Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma.

Abstract

Transarterial chemoembolization (TACE) is a minimally invasive radiological procedure which consists of infusing a chemotherapeutic agent in the main arterial supplier of the liver tumor, usually emulsion-based doxorubicin, followed by the occlusion of the involved vessel with 100–500 micron-sized embolic particles. The direct toxic effect of doxorubicin and the ischemic damage display a dual synergic tumoricidal effect which provokes cell apoptosis and immunogenic changes in the tumor microenvironment, hampering oncogenesis [1]. TACE takes advantage of the hypervascularity of hepatocellular carcinoma (HCC) which, in contrast to the normal liver parenchyma, obtains its blood supply mainly from the hepatic artery and marginally from the portal vein. The true challenge of this technique is to treat the tumor area selectively, minimizing the damage in the surrounding liver parenchyma to decrease the risk of complications and liver recompensation. This supra-selective approach allows the treatment of multiple tumors in patients with chronic liver disease. TACE is considered the standard of care for patients with intermediate-stage hepatocellular carcinoma (HCC) [2,3], which is defined as multinodular disease confined into the liver, in absence of macrovascular invasion and with preserved liver function [4]. In addition, locoregional therapies such as TACE are recommended for patients with early-stage HCC included in the waiting list for liver transplantation unless technically unfeasible [3]. This strategy, usually referred to as bridging, allows the prevention of tumor progression and drop-out