What is the role of transarterial chemoembolization in hepatocellular carcinoma management?

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Transarterial chemoembolization is a locoregional therapy for hepatocellular carcinoma that combines targeted chemotherapy delivery through the hepatic artery feeding the tumor with embolization to block arterial blood flow. The reason this works is that HCC tumors predominantly derive their blood supply from the hepatic artery, unlike most of the surrounding liver tissue which relies more on the portal vein. By catheterizing the tumor’s feeding arteries, a high concentration of chemotherapy is delivered directly to the tumor while embolic material blocks its blood supply. This dual action increases tumor kill and causes ischemic necrosis, while limiting systemic exposure.

This approach is commonly used for patients with intermediate-stage, unresectable HCC or as a bridge/downstaging strategy for transplantation; it is not a systemic chemotherapy regimen, not restricted to post-transplant scenarios, and not simply a tool for planning surgical resection.