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Intra-arterial Chemotherapy and Transarterial Chemoembolization in Hepatocellular Carcinoma

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Liver Cancer in the Middle East

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Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver cancer, representing the sixth leading cause of cancer and the third leading cause of cancer-related mortality. Patient stratification and treatment allocation are based on tumour stage, liver function, and performance status. About 80% of patients with HCC are diagnosed with disease that is not amenable to liver transplantation or surgical resection. A majority of patients with unresectable HCC are referred for image-guided locoregional therapies. These interventional treatments include intra-arterial chemotherapy (IAC), transarterial embolization (TAE), transarterial chemoembolization (TACE) with or without drug-eluting beads (DEBs), and radioembolization using embolic particles loaded with a radioisotope, most commonly Yttrium-90. The main goal of these therapies is to cause an ischemic/hypoxic environment and, consequently, coagulative necrosis in the tumour by delivering selectively chemotherapeutic drugs to the tumour-feeding arteries. The anticancer effect of all embolization procedures is based on terminal arterial blockade and subsequent tumour ischemia. These therapies are accepted treatment modalities for providing survival benefit in selected patient populations. In this chapter, we describe the rationale behind IAC, TAE, conventional transarterial chemoembolization (cTACE), and transarterial chemoembolization (TACE) with drug-eluting beads (DEBs) and provide a review of the existing medical literature regarding the current clinical evidence of safety and efficacy of these therapies, critical appraisal of patient selection, comparison of cTACE and DEB-TACE, and TACE and systemic therapy/immunotherapy combination. Additionally, a brief summary about the TACE implementation in the Middle East countries based on literature screening from PubMed is provided.

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  1. Radiology Department, Cukurova University Medical School, Adana, Adana, Turkey

    Huseyin Tugsan Balli & Kairgeldy Aikimbaev

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  1. Huseyin Tugsan Balli
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  1. Translational HCC Research, Liver Transplantation Institute, Inonu University, Malatya, Turkey

    Brian I. Carr

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Balli, H.T., Aikimbaev, K. (2021). Intra-arterial Chemotherapy and Transarterial Chemoembolization in Hepatocellular Carcinoma. In: Carr, B.I. (eds) Liver Cancer in the Middle East. Springer, Cham. https://doi.org/10.1007/978-3-030-78737-0_10

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