Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: Available evidence and expert opinion on the use of transarterial chemoembolization

Cancer Treatment Reviews

Volumn 37, Issue 3, 2011, Pages 212-220

  Raoul, J L ^a   Sangro, B ^b,c   Forner, A ^d   Mazzaferro, V ^e   Piscaglia, F ^f   Bolondi, L ^f   Lencioni, R ^g  

^a UNIVERSITÉ DE RENNES 1   (France)

^b UNIVERSITY CLINIC OF NAVARRA   (Spain)

^c INSTITUTO DE SALUD CARLOS III   (Spain)

^d UNIVERSITY OF BARCELONA   (Spain)

^e NATIONAL CANCER INSTITUTE   (Italy)

^f UNIVERSITY OF BOLOGNA   (Italy)

^g UNIVERSITY OF PISA   (Italy)

Author keywords

Contraindications; HCC; Hepatocellular carcinoma; Intermediate stage; Sorafenib; TACE; Transarterial chemoembolization

Indexed keywords

CANCER STAGING; CANCER SURVIVAL; CHEMOEMBOLIZATION; CLINICAL DECISION MAKING; HUMAN; LIVER CELL CARCINOMA; META ANALYSIS (TOPIC); PATIENT SELECTION; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; STANDARDIZATION; TREATMENT OUTCOME;

CARCINOMA, HEPATOCELLULAR; CHEMOEMBOLIZATION, THERAPEUTIC; HUMANS; LIVER NEOPLASMS; PRACTICE GUIDELINES AS TOPIC; RANDOMIZED CONTROLLED TRIALS AS TOPIC;

EID: 79952039170     PISSN: 03057372     EISSN: 15321967     Source Type: Journal    
DOI: 10.1016/j.ctrv.2010.07.006     Document Type: Review

References (111)

1. Parkin D.M., Bray F., Ferlay J., et al. Global cancer statistics, 2002. CA Cancer J Clin 2005, 55:74-108.
2. Berrino F., De A.R., Sant M., et al. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study. Lancet Oncol 2007, 8:773-783.
3. Verdecchia A., Francisci S., Brenner H., et al. Recent cancer survival in Europe: a 2000-02 period analysis of EUROCARE-4 data. Lancet Oncol 2007, 8:784-796.
4. Okuda K., Ohtsuki T., Obata H., et al. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 1985, 56:918-928.
5. Sobin L., Wittekind C. International union against cancer: TMN classification of malignant tumours 2007, Wiley-Liss, New York. 6th ed.
6. The Cancer of the Liver Italian Program (CLIP) investigation. Prospective validation of the CLIP score: a new prognostic system for patients with cirrhosis and hepatocellular carcinoma. Hepatolgy 2000;31:840-5.
7. Kudo M., Chung H., Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol 2003, 38:207-215.
8. Leung T.W., Tang A.M., Zee B., et al. Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system: a study based on 926 patients. Cancer 2002, 94:1760-1769.
9. Llovet J.M., Bru C., Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999, 19:329-338.
10. Bruix J., Sherman M., Llovet J.M., et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 2001, 35:421-430.
11. Bruix J., Sherman M. Management of hepatocellular carcinoma. Hepatology 2005, 42:1208-1236.
12. Llovet J.M., Di Bisceglie A.M., Bruix J., et al. Design and endpoints of clinical trials in hepatocellular carcinoma. J Natl Cancer Inst 2008, 100:698-711.
13. Llovet J.M., Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 2003, 37:429-442.
14. Llovet J.M., Real M.I., Montana X., et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002, 359:1734-1739.
15. Lo C.M., Ngan H., Tso W.K., et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002, 35:1164-1171.
16. A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma. Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire. New Engl J Med 1995;332:1256-61.
17. Bruix J., Llovet J.M., Castells A., et al. Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology 1998, 27:1578-1583.
18. Lin D.Y., Liaw Y.F., Lee T.Y., et al. Hepatic arterial embolization in patients with unresectable hepatocellular carcinoma - a randomized controlled trial. Gastroenterology 1988, 94:453-456.
19. Pelletier G., Ducreux M., Gay F., et al. Treatment of unresectable hepatocellular carcinoma with lipiodol chemoembolization: a multicenter randomized trial. Groupe CHC. J Hepatol 1998, 29:129-134.
20. Doffoel M., Bonnetain F., Bouche O., et al. Multicentre randomised phase III trial comparing tamoxifen alone or with transarterial lipiodol chemoembolisation for unresectable hepatocellular carcinoma in cirrhotic patients (Federation Francophone de Cancerologie Digestive 9402). Eur J Cancer 2008, 44:528-538.
21. Camma C., Schepis F., Orlando A., et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology 2002, 224:47-54.
22. Lopez R.R., Pan S.H., Hoffman A.L., et al. Comparison of transarterial chemoembolization in patients with unresectable, diffuse vs focal hepatocellular carcinoma. Arch Surg 2002, 137:653-657.
23. Yuen M.F., Chan A.O., Wong B.C., et al. Transarterial chemoembolization for inoperable, early stage hepatocellular carcinoma in patients with Child-Pugh grade A and B: results of a comparative study in 96 Chinese patients. Am J Gastroenterol 2003, 98:1181-1185.
24. Kothary N., Weintraub J.L., Susman J., et al. Transarterial chemoembolization for primary hepatocellular carcinoma in patients at high risk. J Vasc Interv Radiol 2007, 18:1517-1526.
25. Telesca C., Angelico M., Petrolati A., et al. Early-stage hepatocellular carcinoma: complete ablation predict survival in cirrhotic patients treated by laser ablation (la) combined with selective chemoembolization (sTACE). Hepatology [AASLD Abstracts] 2008, 48(S1):960A. [abstract 1468].
26. Huo T., Huang Y.H., Wu J.C., et al. Comparison of transarterial chemoembolization and percutaneous acetic acid injection as the primary loco-regional therapy for unresectable hepatocellular carcinoma: a prospective survey. Aliment Pharmacol Ther 2004, 19:1301-1308.
27. Ebied O.M., Federle M.P., Carr B.I., et al. Evaluation of responses to chemoembolization in patients with unresectable hepatocellular carcinoma. Cancer 2003, 97:1042-1050.
28. Gunji T., Kawauchi N., Akahane M., et al. Long-term outcomes of transcatheter arterial chemoembolization with autologous blood clot for unresectable hepatocellular carcinoma. Int J Oncol 2002, 21:427-432.
29. El-Serag H.B., Marrero J.A., Rudolph L., et al. Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology 2008, 134:1752-1763.
30. Herber S.C., Otto G., Schneider J., et al. Transarterial chemoembolization in patients not eligible for liver transplantation: single-center results. AJR Am J Roentgenol 2008, 190:1035-1042.
31. Cho Y.K., Chung J.W., Kim J.K., et al. Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Cancer 2008, 112:352-361.
32. Kirchhoff T.D., Bleck J.S., Dettmer A., et al. Transarterial chemoembolization using degradable starch microspheres and iodized oil in the treatment of advanced hepatocellular carcinoma: evaluation of tumor response, toxicity, and survival. Hepatobiliary Pancreat Dis Int 2007, 6:259-266.
33. Takayasu K., Arii S., Ikai I., et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 2006, 131:461-469.
34. Huang Y.H., Wu J.C., Chen S.C., et al. Survival benefit of transcatheter arterial chemoembolization in patients with hepatocellular carcinoma larger than 10cm in diameter. Aliment Pharmacol Ther 2006, 23:129-135.
35. Dumortier J., Chapuis F., Borson O., et al. Unresectable hepatocellular carcinoma: survival and prognostic factors after lipiodol chemoembolisation in 89 patients. Dig Liver Dis 2006, 38:125-133.
36. Jansen M.C., van H.R., Chamuleau R.A., et al. Outcome of regional and local ablative therapies for hepatocellular carcinoma: a collective review. Eur J Surg Oncol 2005, 31:331-347.
37. Bruix J., Sala M., Llovet J.M. Chemoembolization for hepatocellular carcinoma. Gastroenterology 2004, 127:S179-S188.
38. Li X., Feng G.S., Zheng C.S., et al. Expression of plasma vascular endothelial growth factor in patients with hepatocellular carcinoma and effect of transcatheter arterial chemoembolization therapy on plasma vascular endothelial growth factor level. World J Gastroenterol 2004, 10:2878-2882.
39. Guo W.J., Yu E.X., Liu L.M., et al. Comparison between chemoembolization combined with radiotherapy and chemoembolization alone for large hepatocellular carcinoma. World J Gastroenterol 2003, 9:1697-1701.
40. Yamada K., Izaki K., Sugimoto K., et al. Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 2003, 57:113-119.
41. Testa R., Testa E., Giannini E., et al. Trans-catheter arterial chemoembolisation for hepatocellular carcinoma in patients with viral cirrhosis: role of combined staging systems, Cancer Liver Italian Program (CLIP) and Model for End-stage Liver Disease (MELD), in predicting outcome after treatment. Aliment Pharmacol Ther 2003, 17:1563-1569.
42. Grieco A., Marcoccia S., Miele L., et al. Transarterial chemoembolization (TACE) for unresectable hepatocellular carcinoma in cirrhotics: functional hepatic reserve and survival. Hepatogastroenterology 2003, 50:207-212.
43. O'Suilleabhain C.B., Poon R.T., Yong J.L., et al. Factors predictive of 5-year survival after transarterial chemoembolization for inoperable hepatocellular carcinoma. Brit J Surg 2003, 90:325-331.
44. Katyal S., Oliver J.H., Peterson M.S., et al. Prognostic significance of arterial phase CT for prediction of response to transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma: a retrospective analysis. AJR Am J Roentgenol 2000, 175:1665-1672.
45. Kwok P.C., Lam T.W., Chan S.C., et al. A randomized clinical trial comparing autologous blood clot and gelfoam in transarterial chemoembolization for inoperable hepatocellular carcinoma. J Hepatol 2000, 32:955-964.
46. Ueno K., Miyazono N., Inoue H., et al. Transcatheter arterial chemoembolization therapy using iodized oil for patients with unresectable hepatocellular carcinoma: evaluation of three kinds of regimens and analysis of prognostic factors. Cancer 2000, 88:1574-1581.
47. Vogl T.J., Trapp M., Schroeder H., et al. Transarterial chemoembolization for hepatocellular carcinoma: volumetric and morphologic CT criteria for assessment of prognosis and therapeutic success-results from a liver transplantation center. Radiology 2000, 214:349-357.
48. Ernst O., Sergent G., Mizrahi D., et al. Treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization: comparison of planned periodic chemoembolization and chemoembolization based on tumor response. AJR Am J Roentgenol 1999, 172:59-64.
49. Kawai S., Tani M., Okamura J., et al. Prospective and randomized trial of lipiodol-transcatheter arterial chemoembolization for treatment of hepatocellular carcinoma: a comparison of epirubicin and doxorubicin (second cooperative study). The Cooperative Study Group for Liver Cancer Treatment of Japan. Semin Oncol 1997, 24:S6.
50. Florio F., Nardella M., Balzano S., et al. Treatment of hepatocellular carcinoma: a single-center experience. Cardiovasc Intervent Radiol 1997, 20:23-28.
51. Farinati F., De M.N., Marafin C., et al. Unresectable hepatocellular carcinoma in cirrhosis: survival, prognostic factors, and unexpected side effects after transcatheter arterial chemoembolization. Dig Dis Sci 1996, 41:2332-2339.
52. Malaguarnera M., Trovato G., Restuccia S., et al. Treatment of nonresectable hepatocellular carcinoma: review of the literature and meta-analysis. Adv Ther 1994, 11:303-319.
53. Bronowicki J.P., Vetter D., Dumas F., et al. Transcatheter oily chemoembolization for hepatocellular carcinoma. A 4-year study of 127 French patients. Cancer 1994, 74:16-24.
54. Mondazzi L., Bottelli R., Brambilla G., et al. Transarterial oily chemoembolization for the treatment of hepatocellular carcinoma: a multivariate analysis of prognostic factors. Hepatology 1994, 19:1115-1123.
55. Stuart K., Stokes K., Jenkins R., et al. Treatment of hepatocellular carcinoma using doxorubicin/ethiodized oil/gelatin powder chemoembolization. Cancer 1993, 72:3202-3209.
56. Gunji T., Kawauchi N., Ohnishi S., et al. Treatment of hepatocellular carcinoma associated with advanced cirrhosis by transcatheter arterial chemoembolization using autologous blood clot: a preliminary report. Hepatology 1992, 15:252-257.
57. Yang C.F., Ho Y.J. Transcatheter arterial chemoembolization for hepatocellular carcinoma. Cancer Chemother Pharmacol 1992, 31(Suppl.):S86-S88.
58. Hsieh M.Y., Chang W.Y., Wang L.Y., et al. Treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization and analysis of prognostic factors. Cancer Chemother Pharmacol 1992, 31(Suppl.):S82-S85.
59. Bruix J., Castells A., Montanya X., et al. Phase II study of transarterial embolization in European patients with hepatocellular carcinoma: need for controlled trials. Hepatology 1994, 20:643-650.
60. Lencioni R, Malagari K, Vogl T, et al. A randomized phase II trial of a drug eluting bead in the treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization. In: Abstract 116 presented at the ASCO gastrointestinal cancers symposium, San Francisco, CA, USA; 15-17 January 2009.
61. Horiguchi Y., Itoh M., Takawaga H., et al. Assessment of chemoembolization therapy for primary liver cancer using a stabilized adriamycin-lipiodol suspension. Cancer Chemother Pharmacol 1992, 31:S60-S64.
62. Farinati F., Giacomin A., Tartaro P., et al. Intermediate stage HCC: to TACE or not to TACE?. J Hepatol [Abstracts of the International Liver Congress 2009] 2009, 50(Suppl. 1):S288-S289. [abstract 788].
63. Doan P.L., O'Neil B.H., Moore D.T., et al. Predictors of survival in patients with hepatocellular carcinoma treated with transarterial chemoembolization. J Clin Oncol ASCO Annu Meet Proc 2008, 26(15S):15522.
64. Hanks B.A., Suhocki P.V., DeLong D.M., et al. The efficacy and tolerability of transarterial chemo-embolization (TACE) compared with transarterial embolization (TAE) for patients with unresectable hepatocellular carcinoma (HCC). J Clin Oncol ASCO Annu Meet Proc 2008, 26(15S):4595.
65. Lee H.S., Kim J.S., Choi I.J., et al. The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction. A prospective controlled study. Cancer 1997, 79:2087-2094.
66. Lammer J., Malagari K., Vogl T., et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 2010, 33:41-52.
67. Shim J.H., Park J.W., Kim J.H., et al. Association between increment of serum VEGF level and prognosis after transcatheter arterial chemoembolization in hepatocellular carcinoma patients. Cancer Sci 2008, 99:2037-2044.
68. Sergio A., Cristofori C., Cardin R., et al. Transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC): the role of angiogenesis and invasiveness. Am J Gastroenterol 2008, 103:914-921.
69. Okada Y., Ina H., Kubota K., et al. Computed tomography-guided transarterial chemoembolization as the initial therapy for hepatocellular carcinoma: experience of 75 cases in a single institute. Dig Dis Sci 2003, 48:587-593.
70. Saccheri S., Lovaria A., Sangiovanni A., et al. Segmental transcatheter arterial chemoembolization treatment in patients with cirrhosis and inoperable hepatocellular carcinomas. J Vasc Interv Radiol 2002, 13:995-999.
71. Poon R.T., Ngan H., Lo C.M., et al. Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence. J Surg Oncol 2000, 73:109-114.
72. Savastano S., Miotto D., Casarrubea G., et al. Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with child's grade A or B cirrhosis: a multivariate analysis of prognostic factors. J Clin Gastroenterol 1999, 28:334-340.
73. Jaeger H.J., Mehring U.M., Castaneda F., et al. Sequential transarterial chemoembolization for unresectable advanced hepatocellular carcinoma. Cardiovasc Intervent Radiol 1996, 19:388-396.
74. Shah S.R., Riordan S.M., Karani J., et al. Tumour ablation and hepatic decompensation rates in multi-agent chemoembolization of hepatocellular carcinoma. QJM 1998, 91:821-828.
75. Poon R.T., Lau C., Yu W.C., et al. High serum levels of vascular endothelial growth factor predict poor response to transarterial chemoembolization in hepatocellular carcinoma: a prospective study. Oncol Rep 2004, 11:1077-1084.
76. Bayraktar Y., Balkanci F., Kayhan B., et al. A comparison of chemoembolization with conventional chemotherapy and symptomatic treatment in cirrhotic patients with hepatocellular carcinoma. Hepatogastroenterology 1996, 43:681-687.
77. Ahrar K., Gupta S. Hepatic artery embolization for hepatocellular carcinoma: technique, patient selection, and outcomes. Surg Oncol Clin N Am 2003, 12:105-126.
78. Chung J.W., Park J.H., Han J.K., et al. Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology 1996, 198:33-40.
79. Chan A.O., Yuen M.F., Hui C.K., et al. A prospective study regarding the complications of transcatheter intraarterial lipiodol chemoembolization in patients with hepatocellular carcinoma. Cancer 2002, 94:1747-1752.
80. Chen M.S., Li J.Q., Zhang Y.Q., et al. High-dose iodized oil transcatheter arterial chemoembolization for patients with large hepatocellular carcinoma. World J Gastroenterol 2002, 8:74-78.
81. Hwang J.I., Chow W.K., Hung S.W., et al. Development of a safety index of transarterial chemoembolization for hepatocellular carcinoma to prevent acute liver damage. Anticancer Res 2005, 25:2551-2554.
82. Forner A., Ayuso C., Varela M., et al. Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma: are response evaluation criteria in solid tumors reliable?. Cancer 2009, 115:616-623.
83. Greten T.F., Papendorf F., Bleck J.S., et al. Survival rate in patients with hepatocellular carcinoma: a retrospective analysis of 389 patients. Brit J Cancer 2005, 92:1862-1868.
84. Hsieh C.B., Chang H.M., Chen T.W., et al. Comparison of transcatheter arterial chemoembolization, laparoscopic radiofrequency ablation, and conservative treatment for decompensated cirrhotic patients with hepatocellular carcinoma. World J Gastroenterol 2004, 10:505-508.
85. Kagawa T., Kojima T., Numata M., et al. Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for with hepatocellular carcinoma - comparison with surgical resection. Hepatology [AASLD Abstracts] 2008, 48(S1):498A. [abstract 426].
86. Kim J.H., Jung Y.K., Choi J.H., et al. Transarterial chemoembolization could achieved a survival benefit in selected patients who have advanced stage of hepatocellular carcinoma. Hepatology [AASLD Abstracts] 2008, 48(S1):962A. [abstract 1474].
87. Llado L., Virgili J., Figueras J., et al. A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization. Cancer 2000, 88:50-57.
88. Pelletier G., Roche A., Ink O., et al. A randomized trial of hepatic arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Hepatol 1990, 11:181-184.
89. Rougier P., Roche A., Pelletier G., et al. Efficacy of chemoembolization for hepatocellular carcinomas: experience from the Gustave Roussy Institute and the Bicetre Hospital. J Surg Oncol Suppl 1993, 3:94-96.
90. Shen H., Agarwal D., Qi R., et al. Predictors of outcome in patients with unresectable hepatocellular carcinoma receiving transcatheter arterial chemoembolization. Aliment Pharmacol Ther 2007, 26:393-400.
91. Takayasu K., Muramatsu Y., Maeda T., et al. Targeted transarterial oily chemoembolization for small foci of hepatocellular carcinoma using a unified helical CT and angiography system: analysis of factors affecting local recurrence and survival rates. AJR Am J Roentgenol 2001, 176:681-688.
92. Watanabe S., Nishioka M., Ohta Y., et al. Prospective and randomized controlled study of chemoembolization therapy in patients with advanced hepatocellular carcinoma. Cooperative Study Group for Liver Cancer Treatment in Shikoku area. Cancer Chemother Pharmacol 1994, 33(Suppl.):S93-S96.
93. Acunas B., Rozanes I. Hepatocellular carcinoma: treatment with transcatheter arterial chemoembolization. Eur J Radiol 1999, 32:86-89.
94. Befeler A.S. Chemoembolization and bland embolization: a critical appraisal. Clin Liver Dis 2005, 9:287-300.
95. Pleguezuelo M., Germani G., Marelli L., et al. Evidence-based diagnosis and locoregional therapy for hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol 2008, 2:761-784.
96. Pleguezuelo M., Marelli L., Misseri M., et al. TACE versus TAE as therapy for hepatocellular carcinoma. Expert Rev Anticancer Ther 2008, 8:1623-1641.
97. Sikander A., Sadashiv S., Ronald S., et al. Transarterial chemoembolization in a patient with recurrent hepatocellular carcinoma and portal vein thrombosis: a case report and review of the literature. Am J Clin Oncol 2005, 28:638-639.
98. Kettenbach J., Stadler A., Katzler I.V., et al. Drug-loaded microspheres for the treatment of liver cancer: review of current results. Cardiovasc Intervent Radiol 2008, 31:468-476.
99. Lau W.Y., Yu S.C., Lai E.C., et al. Transarterial chemoembolization for hepatocellular carcinoma. J Am Coll Surg 2006, 202:155-168.
100. Monna T., Kanno T., Marumo T., et al. A comparison of transcatheter arterial embolization with one shot therapy for the patients with hepatic cell carcinoma. Gastroenterol Jpn 1982, 17:542-549.
101. Ikeda K., Kumada H., Saitoh S., et al. Effect of repeated transcatheter arterial embolization on the survival time in patients with hepatocellular carcinoma. An analysis by the Cox proportional hazard model. Cancer 1991, 68:2150-2154.
102. Lu W., Li Y., He X., et al. Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with cirrhosis: evaluation of two kinds of dosages of anticancer drugs and analysis of prognostic factors. Hepatogastroenterology 2003, 50:2079-2083.
103. Parikh P., Malhotra H., Jelic S. Hepatocellular carcinoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2008, 19(Suppl. 2):ii27-ii28.
104. Ryder S.D. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults. Gut 2003, 52(Suppl. 3):iii1-iii8.
105. Bartolozzi C., Lencioni R., Caramella D., et al. Treatment of large HCC: transcatheter arterial chemoembolization combined with percutaneous ethanol injection versus repeated transcatheter arterial chemoembolization. Radiology 1995, 197:812-818.
106. Venook A.P., Stagg R.J., Lewis B.J., et al. Chemoembolization for hepatocellular carcinoma. J Clin Oncol 1990, 8:1108-1114.
107. Bruix J., Raoul J.L., Sherman M., et al. Efficacy and safety of sorafenib in patients with hepatocellular carcinoma (HCC): Subanalysis of sharp trial based on Barcelona clinic liver cancer (BCLC) stage. J Hepatol 2009, 50:S28-S29.
108. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers v2.2009. Available at: [accessed April 2009]. http://www.nccn.org.
109. Forner A., Ayuso C., Isabel R.M., et al. Diagnosis and treatment of hepatocellular carcinoma. Med Clin (Barc) 2009, 132:272-287.
110. Barone M., Ettorre G.C., Ladisa R., et al. Transcatheter arterial chemoembolization (TACE) in treatment of hepatocellular carcinoma. Hepatogastroenterology 2003, 50:183-187.
111. Lencioni R., Llovet J. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010, 30:52-60.