European Reviewfor Medicaland Pharmacological Sciences 356 Abstract. – Background and Objectives: to provide an overview on the loco-regional ther- apy performed by transarterial chemoemboliza- tion (TACE) in patients with hepatocellular carci- noma (HCC), either as sole, either as neoadju- vant to surgery or bridge therapy to orthotopic liver transplantation (OLT). Evidence and Information Sources: The current review is based on an analysis of the current literature and the caseload experience of the Authors on this topic. State of the Art: Chemoembolization com- bines de-arterialization of the tumor and selective delivery of chemotherapeutic agents into tumor’s feeding vessels during angiography. Tumor is- chemia raises the drug concentration compared to infusion alone and extends the retention of the chemotherapeutic drug. As locoregional therapy, TACE allows a complete local tumor control of 25- 35% and permits an increase of survival in patients with intermediate HCC according to Barcelona- Clinic Liver Cancer (BCLC) classification. Excellent results were also achieved by combined therapies, such as with percutaneous ethanol injection or ra- diofrequency ablation, as neoadjuvant therapy pri- or to liver resection and in some circumstances as a bridging tool before liver transplantation. Perspectives: Drug eluting beads are micros- pheres that can be loaded with doxorubicin and in- duce toxic and ischemic necrosis with the same de- vice; that allows an increase of drug selectively ex- posed to tumor cells and simultaneously a reduc- tion of systemic toxicity. Tumor embolization in- duces a neoangiogenic reaction with a significant growth of adiacent satellites, so the association with sorafenib has a strong rationale for a com- bined therapy and is currently under investigation. Conclusions: today TACE is the standard of care for treatment of intermediate hepatocellular carcinoma. To get the best performance it should be tailored according to the individual patient’s condition. Key Words: Liver cancer, Hepatocellular carcinoma, Chemoem- bolization, Drug eluting beads, Sorafenib. Transarterial chemoembolization (TACE) for unresectable HCC: A new life begins? M. BIOLATO 1 , G. MARRONE 1 ,S.RACCO 1 ,C.DISTASI 2 ,L.MIELE 1 , G. GASBARRINI 1 , R. LANDOLFI 1 , A. GRIECO 1 1 Institute of Internal Medicine, and 2 Institute of Radiology, School of Medical, Catholic University of the Sacred Heart, Rome (Italy) Corresponding Author: Antonio Grieco, MD; e-mail: agrieco@rm.unicatt.it Introduction Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and the third most common causes of cancer death 1 . In West- ern countries, it develops in a cirrhotic liver in 80% of cases with an annual incidence of 3-5% 2 . Notabily, the incidence of HCC (626,000 cas- es/year worldwide) nearly matches its mortality (598,000 deaths/year worldwide) 1 , underling the poor prognosis; therapeutic options are in fact limited by residual liver function and tumor ex- tension. Barcelona-Clinic Liver Cancer (BCLC) classi- fication is actually the standard system for the clinical management of HCC. To determine the besttherapeuticoptionitconsiderstumorburden, liver function reserve according to Child-Pugh scoreandpatient’sperformancestatus. Curative treatments are proposed in very early andearlystageHCC(BCLCstage0andA)witha 5yearssurvivalof71-93%and50-70%respective- ly.Inthepast,alltumornoteligibleforsurgicalre- section were grouped in the “unresectable” catego- ry. Currently, the evidence of an heterogeneous outcomeamongthesepatientsledtotheidentifica- tion of at least three subgroups of patients with so called unresectable HCC: intermediate (BCLC stage B), with a 16 months median survival in un- treated patients, advanced (BCLC stage C), with 6 months median survival and end-stage HCC (BCLCstageD)with3-4monthssurvival 3,4 . Intheearly’90thediagnosisofHCCwasper- formed mainly in advanced stages: nodules less than 2 cm in diameters represented <5% of cases in Europe. Currently, surveillance programs in high risk patients allows to detect small HCC nodules and an early diagnosis is feasible in 30- 60%ofcases 2 . For many years, surgical resection and liver transplantationhavebeenconsideredtheonlycu- 2010;14:356-362