Indicazione e risultati dei trattamenti locoregionali nell'epatocarcinoma

Transarterial chemoembolization (TACE) is largely used in the treatment of patients with HCC. Many unanswered questions relating to TACE are however still challenging. In the present thesis some controversies surrounding TACE were evaluated including (1) patient selection, (2) multiple TACE and schedules for repeat sessions and (3) TACE as neo-adjuvant treatment in patients awaiting liver transplantation. For the aim of the thesis three studies were reported. TACE is frequently performed outside the current treatment guidelines including a considerable percentage of patients with single nodule, patients with portal vein thrombosis and impaired performance status (PS). Study 1 showed that TACE is a valid treatment option for patients with single nodule of HCC not eligible for curative treatments and that bland portal vein thrombosis and a mild impairment of performance statue (PS-1) likely due to cirrhosis have no impact on survival. Multiple TACE are usually performed in the routine clinical practice but the optimal number of repeated TACE to be performed before switching to another or no treatment is still to be definitely established. Study 2 supported the policy of repeating TACE “on demand” in patients with preserved liver function and not eligible to percutaneous treatments or surgery even if only a limited proportion of patients can be submitted to more TACE cycles. TACE is a common treatment for patients awaiting liver transplant (LT) but no studies evaluating the impact of multiple TACE in those patients are available. Study 3 showed no impact of multiple TACE cycles on tumor necrosis, recurrence or overall survival. On the contrary, patients with a waiting time ?6 months to LT had increased risk of recurrence after LT probably because the tumor biology in those patients had not enough time to be exposed.