Chemoembolization for Hepatocellular Carcinoma: Facts and Misconceptions
The statement that chemoembolization is most commonly used for treatment of resectable hepatocellular carcinoma (HCC) is FALSE. Chemoembolization is primarily recommended for unresectable HCC, particularly in patients with BCLC stage B (intermediate stage) disease 1.
Correct Facts About Chemoembolization
Chemoembolization involves the process of injecting chemotherapeutic drugs combined with embolization particles into the hepatic artery, which is accurate 1.
The mortality rate after initial therapy with chemoembolization is approximately 0.5%, which aligns with published data 1.
Complications of chemoembolization include liver dysfunction or liver failure, hepatic abscess, and hepatic artery thrombosis, which are well-documented adverse events 1.
Why Chemoembolization is NOT Used for Resectable HCC
For resectable HCC, surgical resection or liver transplantation are the only curative therapies and are considered first-line treatments 1.
Chemoembolization is specifically recommended for patients with unresectable HCC, particularly those with:
The EASL-EORTC guidelines explicitly state that chemoembolization is "the most widely used primary treatment for unresectable HCC" and "the recommended first line-therapy for patients at intermediate stage of the disease" 1.
Appropriate Indications for Chemoembolization
Chemoembolization is indicated for patients who are not candidates for curative treatments (resection or transplantation) 1.
It serves as palliative treatment for patients with multinodular HCC without vascular invasion or extrahepatic spread 1.
It can be used as a bridge to liver transplantation when there is a long anticipated waiting time (>6 months) 1.
Contraindications for Chemoembolization
- Decompensated liver disease 1
- Advanced liver dysfunction 1
- Macroscopic vascular invasion 1
- Extrahepatic spread 1
Effectiveness of Chemoembolization
Chemoembolization achieves partial responses in 15-55% of patients and significantly delays tumor progression and macrovascular invasion 1.
The median survival for intermediate HCC cases is expected to be around 16 months, whereas after chemoembolization the median survival is about 20 months 1.
Newer techniques like drug-eluting beads have shown similar response rates to conventional chemoembolization but with fewer systemic adverse events 1.
In conclusion, while chemoembolization is an important treatment modality for HCC, it is primarily indicated for unresectable tumors rather than resectable ones, making statement B incorrect.