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，越来越多的临床证据表明，载药微球可同时发挥缺血阻断与细胞毒性双重作用，其疗效或优于常规经动脉化疗栓塞术，且全身毒性较低。多项随机对照试验已证实，载阿霉素DC Bead栓塞微球（drug-eluting bead doxorubicin, DEBDOX）用于经动脉化疗栓塞术的治疗价值。2012年，伦奇奥尼（Lencioni）等人在《心血管介入放射学（Cardiovasc Intervent Radiol）》2012; 35: 980–985发表了首项被广泛认可的DEBDOX-TACE治疗肝细胞癌的栓塞技术指南，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规范，但相关内容尚未被纳入更新版指南。此外，亚洲与西方人群在基础肝脏病理学特征及经导管栓塞术临床实践方面的差异尚未得到充分阐明，全球不同地区采用的TACE方案仍存在显著差异，主要涉及化疗药物的种类与用量、栓塞材料的选择、对碘化油（Lipiodol）的依赖程度以及导管定位的选择性。上述问题使得系统性解读与对比不同中心的研究结果变得极具挑战。为解决上述问题，本研究召集了一支覆盖肝细胞癌治疗各细分领域的专家小组，制定了一套更新版临床指南建议，以更好地反映近期临床实践经验，并针对中国台湾地区的DEBDOX-TACE临床应用进行定制化调整。本专家小组的相关结论将在下文详述。