Korean Journal of Radiology

  • 제24권7호
  • /
  • Pages.606-625
  • /
  • 2023
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Transarterial Chemoembolization for Hepatocellular Carcinoma: 2023 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association

  • Yuri Cho (Center for Liver and Pancreatobiliary Cancer, National Cancer Center) ;
  • Jin Woo Choi (Department of Radiology, Seoul National University Hospital) ;
  • Hoon Kwon (Department of Radiology, Pusan National University Hospital) ;
  • Kun Yung Kim (Department of Radiology, Jeonbuk National University Hospital) ;
  • Byung Chan Lee (Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • Hee Ho Chu (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Dong Hyeon Lee (Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center) ;
  • Han Ah Lee (Department of Internal Medicine, Ewha Womans University College of Medicine) ;
  • Gyoung Min Kim (Department of Radiology, Yonsei University College of Medicine) ;
  • Jung Suk Oh (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Dongho Hyun (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • In Joon Lee (Department of Radiology, National Cancer Center) ;
  • Hyunchul Rhim (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Research Committee of the Korean Liver Cancer Association (Korean Liver Cancer Association)
  • 투고 : 2023.04.26
  • 심사 : 2023.05.01
  • 발행 : 2023.07.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post- procedural patient care.

키워드

과제정보

This study was supported by Korea Liver Cancer Association.

참고문헌

  1. Yamada R, Nakatsuka H, Nakamura K, Sato M, Itami M, Kobayashi N, et al. Hepatic artery embolization in 32 patients with unresectable hepatoma. Osaka City Med J 1980;26:81-96 
  2. Yamada R, Sato M, Kawabata M, Nakatsuka H, Nakamura K, Takashima S. Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology 1983;148:397-401 
  3. Ohishi H, Yoshimura H, Uchida H, Sakaguchi H, Yoshioka T, Ohue S, et al. Transcatheter arterial embolization using iodized oil (lipiodol) mixed with an anticancer drug for the treatment of hepatocellular carcinoma. Cancer Chemother Pharmacol 1989;23 Suppl:S33-S36 
  4. Varela M, Real MI, Burrel M, Forner A, Sala M, Brunet M, et al. Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 2007;46:474-481 
  5. Llovet JM, Real MI, Montana X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002;359:1734-1739 
  6. Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002;35:1164-1171 
  7. Takayasu K, Arii S, Ikai I, Omata M, Okita K, Ichida T, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 2006;131:461-469 
  8. Takayasu K, Arii S, Kudo M, Ichida T, Matsui O, Izumi N, et al. Superselective transarterial chemoembolization for hepatocellular carcinoma. Validation of treatment algorithm proposed by Japanese guidelines. J Hepatol 2012;56:886-892 
  9. Lencioni R, de Baere T, Soulen MC, Rilling WS, Geschwind JF. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: a systematic review of efficacy and safety data. Hepatology 2016;64:106-116 
  10. Park JW, Chen M, Colombo M, Roberts LR, Schwartz M, Chen PJ, et al. Global patterns of hepatocellular carcinoma management from diagnosis to death: the BRIDGE Study. Liver Int 2015;35:2155-2166 
  11. Kim BK, Kim DY, Han KH, Seong J. Changes in real-life practice for hepatocellular carcinoma patients in the Republic of Korea over a 12-year period: a nationwide random sample study. PLoS One 2019;14:e0223678 
  12. Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea. 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Korean J Radiol 2022;23:1126-1240 
  13. Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea. 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Clin Mol Hepatol 2022;28:583-705 
  14. Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea. 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. J Liver Cancer 2022;23:1-120 
  15. Omata M, Cheng AL, Kokudo N, Kudo M, Lee JM, Jia J, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int 2017;11:317-370 
  16. Reig M, Forner A, Rimola J, Ferrer-Fabrega J, Burrel M, Garcia-Criado A, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol 2022;76:681-693 
  17. Kuo TM, Chang KM, Kao KJ. Why cannot BCLC 0- or A-stage patients receive curative treatment? Gastrointest Tumors 2020;7:125-133 
  18. Choi JW, Kim HC, Lee JH, Yu SJ, Kim YJ, Yoon JH, et al. Transarterial chemoembolization of hepatocellular carcinoma with segmental portal vein tumour thrombus. Eur Radiol 2017;27:1448-1458 
  19. Chan AO, Yuen MF, Hui CK, Tso WK, Lai CL. A prospective study regarding the complications of transcatheter intraarterial lipiodol chemoembolization in patients with hepatocellular carcinoma. Cancer 2002;94:1747-1752 
  20. Chung JW, Park JH, Han JK, Choi BI, Han MC, Lee HS, et al. Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology 1996;198:33-40 
  21. Choi TW, Kim HC, Lee JH, Yu SJ, Kang B, Hur S, et al. The safety and clinical outcomes of chemoembolization in Child-Pugh class C patients with hepatocellular carcinomas. Korean J Radiol 2015;16:1283-1293 
  22. Song SY, Chung JW, Han JK, Lim HG, Koh YH, Park JH, et al. Liver abscess after transcatheter oily chemoembolization for hepatic tumors: incidence, predisposing factors, and clinical outcome. J Vasc Interv Radiol 2001;12:313-320 
  23. Woo S, Chung JW, Hur S, Joo SM, Kim HC, Jae HJ, et al. Liver abscess after transarterial chemoembolization in patients with bilioenteric anastomosis: frequency and risk factors. AJR Am J Roentgenol 2013;200:1370-1377 
  24. Kim W, Clark TW, Baum RA, Soulen MC. Risk factors for liver abscess formation after hepatic chemoembolization. J Vasc Interv Radiol 2001;12:965-968 
  25. de Baere T, Arai Y, Lencioni R, Geschwind JF, Rilling W, Salem R, et al. Treatment of liver tumors with lipiodol TACE: technical recommendations from experts opinion. Cardiovasc Intervent Radiol 2016;39:334-343 
  26. Li B. Prophylactic use of antibiotics for postsurgical infection in c-TACE and DEB-TACE high-risk patients: a case-control study. J Healthc Eng 2022;2022:6203817 
  27. Chen J, Wu G. Retrospective analysis of Chinese patients with hepatocellular carcinoma (HCC) undergoing transcatheter arterial chemoembolization (TACE) with or without prophylactic antibiotic therapy. J Coll Physicians Surg Pak 2018;28:914-918 
  28. Yoshihara S, Yamana H, Akahane M, Kishimoto M, Nishioka Y, Noda T, et al. Association between prophylactic antibiotic use for transarterial chemoembolization and occurrence of liver abscess: a retrospective cohort study. Clin Microbiol Infect 2021;27:1514.e5-1514.e10 
  29. Khan W, Sullivan KL, McCann JW, Gonsalves CF, Sato T, Eschelman DJ, et al. Moxifloxacin prophylaxis for chemoembolization or embolization in patients with previous biliary interventions: a pilot study. AJR Am J Roentgenol 2011;197:W343-W345 
  30. Patel S, Tuite CM, Mondschein JI, Soulen MC. Effectiveness of an aggressive antibiotic regimen for chemoembolization in patients with previous biliary intervention. J Vasc Interv Radiol 2006;17:1931-1934 
  31. Ebisutani C, Sato S, Nishi K, Inoue H, Yoshie T, Kinoshita Y. Antibiotic prophylaxis in transcatheter treatment of hepatocellular carcinoma: an open randomized prospective study of oral versus intravenous administration. Intern Med 2010;49:1059-1065 
  32. Leung DA, Goin JE, Sickles C, Raskay BJ, Soulen MC. Determinants of postembolization syndrome after hepatic chemoembolization. J Vasc Interv Radiol 2001;12:321-326 
  33. Yang H, Seon J, Sung PS, Oh JS, Lee HL, Jang B, et al. Dexamethasone prophylaxis to alleviate postembolization syndrome after transarterial chemoembolization for hepatocellular carcinoma: a randomized, double-blinded, placebo-controlled study. J Vasc Interv Radiol 2017;28:1503-1511.e2 
  34. Sainamthip P, Kongphanich C, Prasongsook N, Chirapongsathorn S. Single dose dexamethasone prophylaxis of postembolisation syndrome after chemoembolisation in hepatocellular carcinoma patient: a randomised, double-blind, placebo-controlled study. World J Clin Cases 2021;9:9059-9069 
  35. Ogasawara S, Chiba T, Ooka Y, Kanogawa N, Motoyama T, Suzuki E, et al. A randomized placebo-controlled trial of prophylactic dexamethasone for transcatheter arterial chemoembolization. Hepatology 2018;67:575-585 
  36. Lyu N, Kong Y, Li X, Guo N, Lai J, Li J, et al. Effect and safety of prophylactic parecoxib for pain control of transarterial chemoembolization in liver cancer: a single-center, parallel-group, randomized trial. J Am Coll Radiol 2022;19(1 Pt A):61-70 
  37. Lv N, Kong Y, Mu L, Pan T, Xie Q, Zhao M. Effect of perioperative parecoxib sodium on postoperative pain control for transcatheter arterial chemoembolization for inoperable hepatocellular carcinoma: a prospective randomized trial. Eur Radiol 2016;26:3492-3499 
  38. Gentilini P. Cirrhosis, renal function and NSAIDs. J Hepatol 1993;19:200-203 
  39. Park CM, Chung JW, Kim HB, Shin SJ, Park JH. Celiac axis stenosis: incidence and etiologies in asymptomatic individuals. Korean J Radiol 2001;2:8-13 
  40. Song SY, Chung JW, Yin YH, Jae HJ, Kim HC, Jeon UB, et al. Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA. Radiology 2010;255:278-288 
  41. Choi TW, Chung JW, Kim HC, Lee M, Choi JW, Jae HJ, et al. Anatomic variations of the hepatic artery in 5625 patients. Radiol Cardiothorac Imaging 2021;3:e210007 
  42. Kwon JW, Chung JW, Song SY, Lim HG, Myung JS, Choi YH, et al. Transcatheter arterial chemoembolization for hepatocellular carcinomas in patients with celiac axis occlusion. J Vasc Interv Radiol 2002;13:689-694 
  43. Moustafa AS, Abdel Aal AK, Ertel N, Saad N, DuBay D, Saddekni S. Chemoembolization of hepatocellular carcinoma with extrahepatic collateral blood supply: anatomic and technical considerations. Radiographics 2017;37:963-977 
  44. Kim HC, Chung JW, Lee W, Jae HJ, Park JH. Recognizing extrahepatic collateral vessels that supply hepatocellular carcinoma to avoid complications of transcatheter arterial chemoembolization. Radiographics 2005;25 Suppl 1:S25-S39 
  45. Chung JW, Kim HC, Yoon JH, Lee HS, Jae HJ, Lee W, et al. Transcatheter arterial chemoembolization of hepatocellular carcinoma: prevalence and causative factors of extrahepatic collateral arteries in 479 patients. Korean J Radiol 2006;7:257-266 
  46. Yoshida K, Matsui O, Miyayama S, Ibukuro K, Yoneda N, Inoue D, et al. Isolated arteries originating from the intrahepatic arteries: anatomy, function, and importance in intervention. J Vasc Interv Radiol 2018;29:531-537.e1 
  47. Song SY, Chung JW, Lim HG, Park JH. Nonhepatic arteries originating from the hepatic arteries: angiographic analysis in 250 patients. J Vasc Interv Radiol 2006;17:461-469 
  48. Kalender WA, Kyriakou Y. Flat-detector computed tomography (FD-CT). Eur Radiol 2007;17:2767-2779 
  49. Virmani S, Ryu RK, Sato KT, Lewandowski RJ, Kulik L, Mulcahy MF, et al. Effect of C-arm angiographic CT on transcatheter arterial chemoembolization of liver tumors. J Vasc Interv Radiol 2007;18:1305-1309 
  50. de Baere T, Ronot M, Chung JW, Golfieri R, Kloeckner R, Park JW, et al. Initiative on superselective conventional transarterial chemoembolization results (INSPIRE). Cardiovasc Intervent Radiol 2022;45:1430-1440 
  51. Lee IJ, Chung JW, Yin YH, Kim HC, Kim YI, Jae HJ, et al. Cone-beam computed tomography (CBCT) hepatic arteriography in chemoembolization for hepatocellular carcinoma: performance depicting tumors and tumor feeders. Cardiovasc Intervent Radiol 2015;38:1218-1230 
  52. Lee IJ, Chung JW. Conventional chemoembolization for hepatocellular carcinoma: role of cone-beam computed tomography guidance. J Liver Cancer 2019;19:19-29 
  53. Miyayama S, Yamashiro M, Hashimoto M, Hashimoto N, Ikuno M, Okumura K, et al. Comparison of local control in transcatheter arterial chemoembolization of hepatocellular carcinoma ≤6 cm with or without intraprocedural monitoring of the embolized area using cone-beam computed tomography. Cardiovasc Intervent Radiol 2014;37:388-395 
  54. Wattanasatesiri T, Kim HC, Choi JW, Lee JH, Joo I, Hur S, et al. Cone-beam CT-guided chemoembolization in patients with complete response after previous chemoembolization but subsequent elevated α-fetoprotein without overt hepatocellular carcinoma. J Vasc Interv Radiol 2019;30:1273-1280 
  55. Iwazawa J, Ohue S, Hashimoto N, Muramoto O, Mitani T. Survival after C-arm CT-assisted chemoembolization of unresectable hepatocellular carcinoma. Eur J Radiol 2012;81:3985-3992 
  56. Lee IJ, Chung JW, Yin YH, Kim HC, Kim YI, Jae HJ, et al. Cone-beam CT hepatic arteriography in chemoembolization for hepatocellular carcinoma: angiographic image quality and its determining factors. J Vasc Interv Radiol 2014;25:1369-1379; quiz 1379- e1361 
  57. Kothary N, Abdelmaksoud MH, Tognolini A, Fahrig R, Rosenberg J, Hovsepian DM, et al. Imaging guidance with C-arm CT: prospective evaluation of its impact on patient radiation exposure during transhepatic arterial chemoembolization. J Vasc Interv Radiol 2011;22:1535-1543 
  58. Matsuo N, Uchida H, Nishimine K, Soda S, Oshima M, Nakano H, et al. Segmental transcatheter hepatic artery chemoembolization with iodized oil for hepatocellular carcinoma: antitumor effect and influence on normal tissue. J Vasc Interv Radiol 1993;4:543-549 
  59. Matsui O, Kadoya M, Yoshikawa J, Gabata T, Arai K, Demachi H, et al. Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization. Radiology 1993;188:79-83 
  60. Miyayama S, Matsui O, Yamashiro M, Ryu Y, Kaito K, Ozaki K, et al. Ultraselective transcatheter arterial chemoembolization with a 2-f tip microcatheter for small hepatocellular carcinomas: relationship between local tumor recurrence and visualization of the portal vein with iodized oil. J Vasc Interv Radiol 2007;18:365-376 
  61. Golfieri R, Cappelli A, Cucchetti A, Piscaglia F, Carpenzano M, Peri E, et al. Efficacy of selective transarterial chemoembolization in inducing tumor necrosis in small (<5 cm) hepatocellular carcinomas. Hepatology 2011;53:1580-1589 
  62. Yamakado K, Miyayama S, Hirota S, Mizunuma K, Nakamura K, Inaba Y, et al. Hepatic arterial embolization for unresectable hepatocellular carcinomas: do technical factors affect prognosis? Jpn J Radiol 2012;30:560-566 
  63. Arizumi T, Ueshima K, Iwanishi M, Minami T, Chishina H, Kono M, et al. Validation of a modified substaging system (Kinki Criteria) for patients with intermediate-stage hepatocellular carcinoma. Oncology 2015;89 Suppl 2:47-52 
  64. Yasui Y, Tsuchiya K, Kurosaki M, Takeguchi T, Takeguchi Y, Okada M, et al. Up-to-seven criteria as a useful predictor for tumor downstaging to within Milan criteria and Child-Pugh grade deterioration after initial conventional transarterial chemoembolization. Hepatol Res 2018;48:442-450 
  65. Molgaard CP, Teitelbaum GP, Pentecost MJ, Finck EJ, Davis SH, Dziubinski JE, et al. Intraarterial administration of lidocaine for analgesia in hepatic chemoembolization. J Vasc Interv Radiol 1990;1:81-85 
  66. Lee SH, Hahn ST, Park SH. Intraarterial lidocaine administration for relief of pain resulting from transarterial chemoembolization of hepatocellular carcinoma: its effectiveness and optimal timing of administration. Cardiovasc Intervent Radiol 2001;24:368-371 
  67. Benzakoun J, Ronot M, Lagadec M, Allaham W, Garcia Alba C, Sibert A, et al. Risks factors for severe pain after selective liver transarterial chemoembolization. Liver Int 2017;37:583-591 
  68. Liu YS, Lin CY, Chuang MT, Tsai YS, Wang CK, Ou MC. Nitroglycerine use in transcatheter arterial (chemo) embolization in patients with hepatocellular carcinoma: five-year retrospective study. Clin Res Hepatol Gastroenterol 2018;42:542-552 
  69. Katsanos K, Kitrou P, Spiliopoulos S, Maroulis I, Petsas T, Karnabatidis D. Comparative effectiveness of different transarterial embolization therapies alone or in combination with local ablative or adjuvant systemic treatments for unresectable hepatocellular carcinoma: a network meta-analysis of randomized controlled trials. PLoS One 2017;12:e0184597 
  70. Ikeda M, Arai Y, Inaba Y, Tanaka T, Sugawara S, Kodama Y, et al. Conventional or drug-eluting beads? Randomized controlled study of chemoembolization for hepatocellular carcinoma: JIVROSG-1302. Liver Cancer 2022;11:440-450 
  71. Lee IJ, Lee JH, Lee YB, Kim YJ, Yoon JH, Yin YH, et al. Effectiveness of drug-eluting bead transarterial chemoembolization versus conventional transarterial chemoembolization for small hepatocellular carcinoma in Child-Pugh class A patients. Ther Adv Med Oncol 2019;11:1758835919866072 
  72. Chung JW, Park JH, Im JG, Han JK, Han MC. Pulmonary oil embolism after transcatheter oily chemoembolization of hepatocellular carcinoma. Radiology 1993;187:689-693 
  73. Deschamps F, Moine L, Isoardo T, Tselikas L, Paci A, Mir LM, et al. Parameters for stable water-in-oil lipiodol emulsion for liver trans-arterial chemo-eembolization. Cardiovasc Intervent Radiol 2017;40:1927-1932 
  74. He MK, Zou RH, Wei W, Shen JX, Zhao M, Zhang YF, et al. Comparison of stable and unstable ethiodized oil emulsions for transarterial chemoembolization of hepatocellular carcinoma: results of a single-center double-blind prospective randomized controlled trial. J Vasc Interv Radiol 2018;29:1068-1077.e2 
  75. Choi JW, Cho HJ, Park JH, Baek SY, Chung JW, Kim DD, et al. Comparison of drug release and pharmacokinetics after transarterial chemoembolization using diverse lipiodol emulsions and drug-eluting beads. PLoS One 2014;9:e115898 
  76. Craig P, Young S, Golzarian J. Current trends in the treatment of hepatocellular carcinoma with transarterial embolization: variability in technical aspects. Cardiovasc Intervent Radiol 2019;42:1322-1328 
  77. Boulin M, Schmitt A, Delhom E, Cercueil JP, Wendremaire M, Imbs DC, et al. Improved stability of lipiodol-drug emulsion for transarterial chemoembolisation of hepatocellular carcinoma results in improved pharmacokinetic profile: proof of concept using idarubicin. Eur Radiol 2016;26:601-609 
  78. Roth GS, Teyssier Y, Abousalihac M, Seigneurin A, Ghelfi J, Sengel C, et al. Idarubicin vs doxorubicin in transarterial chemoembolization of intermediate stage hepatocellular carcinoma. World J Gastroenterol 2020;26:324-334 
  79. Yoon HM, Kim JH, Kim EJ, Gwon DI, Ko GY, Ko HK. Modified cisplatin-based transcatheter arterial chemoembolization for large hepatocellular carcinoma: multivariate analysis of predictive factors for tumor response and survival in a 163-patient cohort. J Vasc Interv Radiol 2013;24:1639-1646 
  80. Yoon SM, Ryoo BY, Lee SJ, Kim JH, Shin JH, An JH, et al. Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs sorafenib in hepatocellular carcinoma with macroscopic vascular invasion: a randomized clinical trial. JAMA Oncol 2018;4:661-669 
  81. Chung GE, Lee JH, Kim HY, Hwang SY, Kim JS, Chung JW, et al. Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology 2011;258:627-634 
  82. Kim HC, Lee JH, Chung JW, Kang B, Yoon JH, Kim YJ, et al. Transarterial chemoembolization with additional cisplatin infusion for hepatocellular carcinoma invading the hepatic vein. J Vasc Interv Radiol 2013;24:274-283 
  83. Takayasu K, Arii S, Ikai I, Kudo M, Matsuyama Y, Kojiro M, et al. Overall survival after transarterial lipiodol infusion chemotherapy with or without embolization for unresectable hepatocellular carcinoma: propensity score analysis. AJR Am J Roentgenol 2010;194:830-837 
  84. Takayasu K, Shima Y, Muramatsu Y, Moriyama N, Yamada T, Makuuchi M, et al. Hepatocellular carcinoma: treatment with intraarterial iodized oil with and without chemotherapeutic agents. Radiology 1987;163:345-351 
  85. Clouse ME, Stokes KR, Kruskal JB, Perry LJ, Stuart KE, Nasser IA. Chemoembolization for hepatocellular carcinoma: epinephrine followed by a doxorubicin-ethiodized oil emulsion and gelatin sponge powder. J Vasc Interv Radiol 1993;4:717-725 
  86. Louail B, Sapoval M, Bonneau M, Wasseff M, Senechal Q, Gaux JC. A new porcine sponge material for temporary embolization: an experimental short-term pilot study in swine. Cardiovasc Intervent Radiol 2006;29:826-831 
  87. Miyayama S, Mitsui T, Zen Y, Sudo Y, Yamashiro M, Okuda M, et al. Histopathological findings after ultraselective transcatheter arterial chemoembolization for hepatocellular carcinoma. Hepatol Res 2009;39:374-381 
  88. Sacco R, Bargellini I, Bertini M, Bozzi E, Romano A, Petruzzi P, et al. Conventional versus doxorubicin-eluting bead transarterial chemoembolization for hepatocellular carcinoma. J Vasc Interv Radiol 2011;22:1545-1552 
  89. Lammer J, Malagari K, Vogl T, Pilleul F, Denys A, Watkinson A, 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 
  90. Golfieri R, Giampalma E, Renzulli M, Cioni R, Bargellini I, Bartolozzi C, et al. Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. Br J Cancer 2014;111:255-264 
  91. Monier A, Guiu B, Duran R, Aho S, Bize P, Deltenre P, et al. Liver and biliary damages following transarterial chemoembolization of hepatocellular carcinoma: comparison between drug-eluting beads and lipiodol emulsion. Eur Radiol 2017;27:1431-1439 
  92. Lee M, Chung JW, Lee KH, Won JY, Chun HJ, Lee HC, et al. Prospective multi-center Korean registry of transcatheter arterial chemoembolization with drug-eluting embolics for nodular hepatocellular carcinoma: a two-year outcome analysis. Korean J Radiol 2021;22:1658-1670 
  93. Spreafico C, Cascella T, Facciorusso A, Sposito C, Rodolfo L, Morosi C, et al. Transarterial chemoembolization for hepatocellular carcinoma with a new generation of beads: clinical-radiological outcomes and safety profile. Cardiovasc Intervent Radiol 2015;38:129-134 
  94. Prajapati HJ, Xing M, Spivey JR, Hanish SI, El-Rayes BF, Kauh JS, et al. Survival, efficacy, and safety of small versus large doxorubicin drug-eluting beads TACE chemoembolization in patients with unresectable HCC. AJR Am J Roentgenol 2014;203:W706-W714 
  95. Deipolyi AR, Oklu R, Al-Ansari S, Zhu AX, Goyal L, Ganguli S. Safety and efficacy of 70-150 mum and 100-300 mum drug-eluting bead transarterial chemoembolization for hepatocellular carcinoma. J Vasc Interv Radiol 2015;26:516-522 
  96. Urbano J, Echevarria-Uraga JJ, Ciampi-Dopazo JJ, Sanchez-Corral JA, Cobos Alonso J, Anton-Ladislao A, et al. Multicentre prospective study of drug-eluting bead chemoembolisation safety using tightly calibrated small microspheres in non-resectable hepatocellular carcinoma. Eur J Radiol 2020;126:108966 
  97. Irie T, Kuramochi M, Takahashi N. Diameter of main tumor feeding artery of a hepatocellular carcinoma: Measurement at the entry site into the nodule. Hepatol Res 2016;46:E100-E104 
  98. Lee KH, Liapi E, Vossen JA, Buijs M, Ventura VP, Georgiades C, et al. Distribution of iron oxide-containing Embosphere particles after transcatheter arterial embolization in an animal model of liver cancer: evaluation with MR imaging and implication for therapy. J Vasc Interv Radiol 2008;19:1490-1496 
  99. Malagari K, Pomoni M, Kelekis A, Pomoni A, Dourakis S, Spyridopoulos T, et al. Prospective randomized comparison of chemoembolization with doxorubicin-eluting beads and bland embolization with BeadBlock for hepatocellular carcinoma. Cardiovasc Intervent Radiol 2010;33:541-551 
  100. Brown KT, Do RK, Gonen M, Covey AM, Getrajdman GI, Sofocleous CT, et al. Randomized trial of hepatic artery embolization for hepatocellular carcinoma using doxorubicin-eluting microspheres compared with embolization with microspheres alone. J Clin Oncol 2016;34:2046-2053 
  101. Aliberti C, Carandina R, Lonardi S, Dadduzio V, Vitale A, Gringeri E, et al. Transarterial chemoembolization with small drug-eluting beads in patients with hepatocellular carcinoma: experience from a cohort of 421 patients at an Italian center. J Vasc Interv Radiol 2017;28:1495-1502 
  102. Lencioni R, de Baere T, Burrel M, Caridi JG, Lammer J, Malagari K, et al. Transcatheter treatment of hepatocellular carcinoma with doxorubicin-loaded DC bead (DEBDOX): technical recommendations. Cardiovasc Intervent Radiol 2012;35:980-985 
  103. Seki A, Hori S, Shimono C. Management of vascular lake phenomenon on angiography during chemoembolization with superabsorbent polymer microspheres. Jpn J Radiol 2015;33:741-748 
  104. Li H, Wang M, Chen P, Li F, Kuang D, Han X, et al. Occurrence, related factors and prognostic value of vascular lake in hepatocellular carcinoma patients treated with drug-eluting bead transarterial chemoembolization. Onco Targets Ther 2021;14:4659-4670 
  105. Kong J, Jiang X, Zhang Y, Wang W, Li Y, Shen X, et al. Clinical management of vascular lake during transarterial chemoembolization with CalliSpheres drug-eluting beads (DEBs) for the treatment of hepatocellular carcinoma. Transl Cancer Res 2020;9:2895-2903 
  106. Chang PY, Huang CC, Hung CH, Yu CY, Wu DK, Hwang JI, et al. Multidisciplinary Taiwan consensus recommendations for the use of DEBDOX-TACE in hepatocellular carcinoma treatment. Liver Cancer 2018;7:312-322 
  107. Guiu B, Deschamps F, Aho S, Munck F, Dromain C, Boige V, et al. Liver/biliary injuries following chemoembolisation of endocrine tumours and hepatocellular carcinoma: lipiodol vs. drug-eluting beads. J Hepatol 2012;56:609-617 
  108. Malagari K, Pomoni M, Spyridopoulos TN, Moschouris H, Kelekis A, Dourakis S, et al. Safety profile of sequential transcatheter chemoembolization with DC Bead(TM): results of 237 hepatocellular carcinoma (HCC) patients. Cardiovasc Intervent Radiol 2011;34:774-785 
  109. Piscaglia F, Ogasawara S. Patient selection for transarterial chemoembolization in hepatocellular carcinoma: importance of benefit/risk assessment. Liver Cancer 2018;7:104-119 
  110. Gaba RC, Lokken RP, Hickey RM, Lipnik AJ, Lewandowski RJ, Salem R, et al. Quality improvement guidelines for transarterial chemoembolization and embolization of hepatic malignancy. J Vasc Interv Radiol 2017;28:1210-1223.e3 
  111. Miyayama S, Yamashiro M, Okuda M, Yoshie Y, Nakashima Y, Ikeno H, et al. Main bile duct stricture occurring after transcatheter arterial chemoembolization for hepatocellular carcinoma. Cardiovasc Intervent Radiol 2010;33:1168-1179 
  112. Ganguli S, Faintuch S, Salazar GM, Rabkin DJ. Postembolization syndrome: changes in white blood cell counts immediately after uterine artery embolization. J Vasc Interv Radiol 2008;19:443-445 
  113. Casadaban LC, Minocha J, Bui JT, Knuttinen MG, Ray CE Jr, Gaba RC. Conventional ethiodized oil transarterial chemoembolization for treatment of hepatocellular carcinoma: contemporary single-center review of clinical outcomes. AJR Am J Roentgenol 2016;206:645-654 
  114. Shim JH, Park JW, Choi JI, Kim HB, Lee WJ, Kim CM. Does postembolization fever after chemoembolization have prognostic significance for survival in patients with unresectable hepatocellular carcinoma? J Vasc Interv Radiol 2009;20:209-216 
  115. Guo JG, Zhao LP, Rao YF, Gao YP, Guo XJ, Zhou TY, et al. Novel multimodal analgesia regimen improves post-TACE pain in patients with hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2018;17:510-516 
  116. Lu H, Zheng C, Liang B, Xiong B. Mechanism and risk factors of nausea and vomiting after TACE: a retrospective analysis. BMC Cancer 2021;21:513 
  117. Lv WF, Lu D, He YS, Xiao JK, Zhou CZ, Cheng DL. Liver abscess formation following transarterial chemoembolization: clinical reatures, risk factors, bacteria spectrum, and percutaneous catheter drainage. Medicine (Baltimore) 2016;95:e3503 
  118. Arslan M, Degirmencioglu S. Liver abscesses after transcatheter arterial embolization. J Int Med Res 2019;47:1124-1130 
  119. Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010;30:52-60 
  120. Edeline J, Boucher E, Rolland Y, Vauleon E, Pracht M, Perrin C, et al. Comparison of tumor response by Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST in patients treated with sorafenib for hepatocellular carcinoma. Cancer 2012;118:147-156 
  121. Yamanaka K, Hatano E, Kitamura K, Iida T, Ishii T, Machimito T, et al. Early evaluation of transcatheter arterial chemoembolization-refractory hepatocellular carcinoma. J Gastroenterol 2012;47:343-346 
  122. Park JW, Amarapurkar D, Chao Y, Chen PJ, Geschwind JF, Goh KL, et al. Consensus recommendations and review by an international Expert Panel on Interventions in Hepatocellular Carcinoma (EPOIHCC). Liver Int 2013;33:327-337 
  123. Choi J, Lee D, Shim JH, Kim KM, Lim YS, Lee YS, et al. Evaluation of transarterial chemoembolization refractoriness in patients with hepatocellular carcinoma. PLoS One 2020;15:e0229696 
  124. Rhee H, Nahm JH, Kim H, Choi GH, Yoo JE, Lee HS, et al. Poor outcome of hepatocellular carcinoma with stemness marker under hypoxia: resistance to transarterial chemoembolization. Mod Pathol 2016;29:1038-1049