Professional Statements and Societal Positions Guidelines
NCCN Guidelines Hepatocellular Carcinoma-2021
The NCCN(v. 1.2021) guidelines on hepatocellular carcinoma list TACE as an option for patients who are not candidates for surgically curative treatments or as a part of a strategy to bridge patients for other curative therapies (category 2A). The guidelines also recommend that patients with tumors size between 3 and 5 cm can be considered for arterially-directed therapy or combination therapy with ablation and arterial embolization, and those with unresectable or inoperable tumors greater than 5 cm can be treated using arterial embolic approaches , systemic therapies, or external beam radiation therapy. Additionally, TACE in highly selected patients has been shown to be safe in the presence of limited tumor invasion of the portal vein. The American Association for the Study of Liver Diseases 2018 guidelines on hepatocellular carcinoma suggest using liver-directed therapies (which may include TACE) for bridging to liver transplant in patients with T2 lesions, in order to prevent disease progression and prevent dropouts from the waiting list. The guidelines recommend the use of locoregional therapies, including TACE, in patients with cirrhosis and T2 or T3 disease that is not amenable to resection or transplantation.
NCCN Guidelines Intrahepatic Cholangiocarcinoma-2020
The NCCN (v. 3.2020) guidelines on intrahepatic cholangiocarcinoma consider arterially directed therapies, including TACE, to be treatment options for unresectable and metastatic intrahepatic cholangiocarcinoma.
NCCN Guidelines Neuroendocrine Tumors, Carcinoid, and Islet Cell Tumors-2020
The NCCN (v.2.2020) guidelines on neuroendocrine tumors, carcinoid, and islet cell tumors consider chemoembolization as an effective approach for patients with hepatic-predominant metastatic disease (category 2A).
NCCN Guidelines Uveal Cancer-2021
The NCCN (v.1.2021) guidelines on uveal melanoma state that in patients with disease that is confined to the liver, regional liver-directed therapies such as chemoembolization, radioembolization, or immunoembolization should be considered. The use of TACE is not specifically addressed.
NCCN Guidelines Colon Cancer-2021
The NCCN (v. 2.2021) guidelines on colon cancer recommend TACE only for clinical trials. The American Society of Clinical Oncology (2020) resource-stratified guidelines on late-stage colorectal cancer state that patients with unresectable liver metastases may receive TACE (weak recommendation). However, this recommendation should only be implemented in centers with expertise in the technique, after multidisciplinary review, or in the context of a clinical trial.