Abstract
Transarterial chemoembolization (TACE) is a relatively new endovascular treatment based on the minimally invasive induction of tumor necrosis by a high local concentration of a chemotherapeutic agent and an embolic effect. The embolic effect causes ischemia on the one hand and an increased local dwell time of the chemotherapeutic agent in the tumor on the other. Nowadays TACE represents one of the most used treatments for unresectable hepatocellular carcinoma and is the treatment of first choice for patients with intermediate HCC stage BCLC B. However, there is no consensus about the choice of the best embolotherapy technique.
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1.1 Questions
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1.
Which statement is correct:
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(a)
According to the EASL guidelines for HCC, TACE should primarily be performed in patients with advanced HCC stage BCLC C.
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(b)
TACE may be considered for patients with early HCC stage BCLC A.
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(c)
The evidence for benefits of TACE in patients with intermediate HCC Stage BCLC B compared to system therapy with sorafenib is scarce.
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(d)
If, after two treatments with TACE, tumor progression is observed, at least a third treatment session should be performed.
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(a)
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2.
Which statement is correct:
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(a)
DSM-TACE has a vessel occlusion time of approximately 6 weeks.
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(b)
DEB-TACE is more suitable for lesser selective embolizations in disseminated disease than cTACE.
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(c)
Transradial approach has a lower risk for adverse events compared to brachial and femoral approach.
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(d)
To induce maximum tumor-necrosis, chemoembolization with DSM must be followed by embolizing particles like calibrated microspheres or gelfoam.
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(a)
1.2 Answers
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1.
Which statement is correct:
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(a)
TACE is the treatment of choice for patients with HCC BCLC B. Recent studies suggest, that patients with HCC stage BCLC C and segmental portal vein infiltration may profit from TACE.
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(b)
Patients with early HCC stage BCLC A may be treated with TACE if resection or ablation is not possible, this procedure is called stage migration. CORRECT.
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(c)
Evidence for TACE as first line treatment in patients with intermediate HCC Stage BCLC B is strong.
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(d)
If tumor progression or a non-response to TACE is observed after two treatments, no further TACE should be administered and therapy should be switched to system therapy.
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(a)
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2.
Which statement is correct:
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(a)
Vessel occlusion time of DSM-TACE is approximately 35–50 min.
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(b)
Tumor feeders should be probed as superselective as possible when performing cTACE and DEB-TACE.
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(c)
Transradial approach has a significantly lower risk for adverse events compared to brachial and femoral approach. CORRECT.
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(d)
Application of embolizing particles like absorbable gelatin, degradable starch microspheres or permanent materials including polyvinyl alcohols, uncalibrated and calibrated microspheres
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(a)
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Luerken, L., Beyer, L. (2020). Embolization Therapy for Liver Cancer. In: Radu-Ionita, F., Pyrsopoulos, N., Jinga, M., Tintoiu, I., Sun, Z., Bontas, E. (eds) Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-24432-3_60
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DOI: https://doi.org/10.1007/978-3-030-24432-3_60
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