Applying Superselective Conventional TACE

T ransarterial chemoembolization (TACE) is the most commonly performed therapy for inoperable hepatocellular carcinoma (HCC), and a complete response after the initial TACE or during the treatment course is the most robust predictor of a favorable outcome.1 TACE loads hypoxic and chemotherapeutic stress on HCC, and surviving tumors frequently change to a sarcomatous appearance2 or show a mixed hepatocholangiocellular phenotype3 and are usually more aggressive and TACE resistant. Hypoxia induced by TACE also stimulates vascular endothelial growth factor production by the residual tumor cells, which may be a potential cause of recurrent disease.4 Furthermore, some surviving tumors are fed by portal blood if the arterial branches, including extrahepatic collaterals, are severely damaged.5 This suggests that uncontrollable tumors may develop as a result of TACE, and “curative TACE” is necessary to realize a good prognosis.