Erratum: Transarterial Chemoembolization Failure/Refractoriness: JSH-LCSGJ Criteria 2014 Update

In the 2010 version of the Japan Society of Hepatology (JSH) consensus-based treatment algorithm for the management of hepatocellular carcinoma (HCC), transarterial chemoembolization (TACE) failure/refractoriness was defined assuming the use of superselective lipiodol TACE, which has been widely used worldwide and particularly in Japan, and areas with lipiodol deposition were considered to be necrotic. However, this concept is not well accepted internationally. Furthermore, following the approval of microspheres, an embolic material that does not use lipiodol, in February 2014 in Japan, the phrase ‘lipiodol deposition' needed to be changed to ‘necrotic lesion or viable lesion'. Accordingly, the respective section in the JSH guidelines was revised to define TACE failure as an insufficient response after ≥2 consecutive TACE procedures that is evident on response evaluation computed tomography or magnetic resonance imaging after 1-3 months, even after chemotherapeutic agents have been changed and/or the feeding artery has been reanalyzed. In addition, the appearance of a higher number of lesions in the liver than that recorded at the previous TACE procedure (other than the nodule being treated) was added to the definition of TACE failure/refractoriness. Following the discussion of other issues concerning the continuous elevation of tumor markers, vascular invasion, and extrahepatic spread, descriptions similar to those in the previous version were approved. The revision of these TACE failure definitions was approved by over 85% of HCC experts. © 2014 S. Karger AG, Basel

2010版日本肝病学会（Japan Society of Hepatology, JSH）基于共识的肝细胞癌（hepatocellular carcinoma, HCC）诊疗算法中，经动脉化疗栓塞术（transarterial chemoembolization, TACE）失败/难治的定义，以超选择性碘化油经动脉化疗栓塞术（superselective lipiodol TACE）的应用为前提——该术式已在全球尤其是日本广泛普及，且当时认为碘化油沉积区域即为坏死组织。但这一概念在国际范围内并未获得广泛认可。2014年2月，日本批准了微球（microspheres），一种无需使用碘化油的栓塞材料，此时“碘化油沉积”这一表述需更改为“坏死病灶或活性病灶”。据此，JSH指南中的相关章节进行了修订，将TACE失败定义为：经≥2次连续TACE治疗后，即使更换化疗药物并/或重新分析供血动脉，在术后1~3个月的疗效评估计算机断层扫描（computed tomography, CT）或磁共振成像（magnetic resonance imaging, MRI）中仍可见应答不足；此外，肝脏内出现较前次TACE手术时更多的病灶（除外正在接受治疗的结节），也被纳入TACE失败/难治的定义范畴。针对肿瘤标志物持续升高、血管侵犯及肝外转移等其他相关问题的讨论后，指南保留了与旧版一致的相关表述。本次TACE失败定义的修订获得了超过85%的HCC专家的表决通过。© 2014 S. Karger AG, Basel