Supplementary Material for: Multidisciplinary Taiwan Consensus Recommendations for the Use of DEBDOX-TACE in Hepatocellular Carcinoma Treatment

Transarterial chemoembolization (TACE) is the first-line treatment in patients with unresectable hepatocellular carcinoma (HCC). In recent years, there has been increasing clinical evidence that drug-eluting beads provide a combined ischemic and cytotoxic effect that may be superior to conventional TACE, with low systemic toxicity. The therapeutic value of TACE performed using the embolic microsphere DC Bead loaded with doxorubicin (drug-eluting bead doxorubicin [DEBDOX]) has been shown by several randomized controlled trials. Since Lencioni et al. [Cardiovasc Intervent Radiol 2012; 35: 980–985] published the first widely accepted technical recommendations on HCC embolization with DEBDOX-TACE in 2012, new studies have contributed to a better understanding of when and how to apply this new therapeutic modality, and they have yet to be incorporated into an updated guideline. Additionally, differences in the underlying liver pathology and practice of transcatheter embolization between Asian and Western populations have not been adequately addressed, and there remain significant variations in the TACE protocols adopted in different parts of the world. These mainly revolve around the number and type of chemotherapeutic agents used, type of embolic material, reliance on Lipiodol, and selectivity of catheter positioning. As a result of these issues, it has been difficult to interpret and compare results obtained from different centers in a systematic fashion. To address these concerns, we convened a panel of experts specializing in different aspects of HCC treatment to craft an updated set of recommendations that better reflect recent clinical experiences and are tailored to the use of DEBDOX-TACE in Taiwan. The conclusions of this expert panel are described in the following article.

经动脉化疗栓塞术（Transarterial chemoembolization, TACE）是不可切除肝细胞癌（hepatocellular carcinoma, HCC）患者的一线治疗方案。近年来，越来越多临床证据表明，载药微球（drug-eluting beads）可同时发挥缺血阻断与细胞毒性双重作用，疗效或优于常规经动脉化疗栓塞术，且全身毒性更低。多项随机对照试验已证实，采用负载多柔比星的栓塞微球DC Bead（drug-eluting bead doxorubicin, DEBDOX）实施的经动脉化疗栓塞术，其治疗价值已得到验证。2012年，Lencioni等人于《Cardiovasc Intervent Radiol》期刊（2012;35:980–985）发表了首项被广泛认可的DEBDOX-TACE治疗肝细胞癌栓塞技术规范，此后多项新研究进一步明确了该新型治疗手段的适用时机与操作方案，但相关内容尚未被纳入更新版指南。此外，东西方人群在基础肝脏病理学特征与经导管栓塞术临床实践方面的差异尚未得到充分考量，全球不同地区所采用的TACE方案仍存在显著分歧，这些分歧主要集中在化疗药物的种类与剂量、栓塞材料类型、碘化油（Lipiodol）的使用依赖程度以及导管定位的选择性等维度。上述问题导致系统性解读与比较不同中心的研究结果存在较大困难。为解决上述问题，我们召集了一批聚焦肝细胞癌治疗不同领域的专家，制定了一套更新版技术推荐方案，以更好地贴合当前临床实践经验，并适配中国台湾地区DEBDOX-TACE的临床应用场景。本专家共识小组的相关结论将在下文详述。