Mohammad Amin Dehghani - Young Researchers and Elite Club, Yasooj Branch, Islamic Azad University, Yasooj, Iran
Seyyed Hossein Hassanpour - Young Researchers and Elite Club, Yasooj Branch, Islamic Azad University, Yasooj, Iran
Fatemeh Dehghani - Department of Genetics, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Mohammad Shafiei - School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Background and aim: Hepatocellular carcinoma (HCC) makes less than 30% of patients to be candidates for liver resection. Accordingly, multidisciplinary therapists, including surgeon, oncologist, interventional radiologist, radiologist and pathologist, should be involved in the selection of therapeutic strategy. There are many indications for local transarterial approaches, such as transarterial embolization (TAE), conventional transarterial chemoembolization (cTACE) and transarterial chemoembolization performed with drug-eluting beads (DEB-TACE). Materials and methods: The search strategy was to find articles on PubMed database and findings at recent meetings y keywords of hepatocellular carcinoma, TAE, cTACE, transarterial chemoembolization and treatment. Results: The angiogenesis biomarkers are changed due to all chemotherapeutic drugs used in TACE. Ex vivo surgical samples have been evaluated after resection of HCCs treated with TACE in two studies, , including the investigation of correlation of prognosis with expression of genes regulated by HIF-1α in HCC patients receiving preoperative TACE, whose findings revealed the association of preoperative TACE with a significant increased recurrence rate at 2 years, with shorter disease-free survival time. The proangiogenic response sustained by hypoxia of persistent viable tumor was activated by TAE inducing HCC ischemic necrosis, having adverse effect of promoting tumor viability. Conclusion: According to multivariate analysis, the TACE was reported to be an independent negative prognostic factor for recurrence and disease-free survival; it has been shown as standard therapy for unrespectable HCC. Treatment failure can be seen in the hypoxia-induced angiogenesis by TACE. A survival chance has been found by emerging targeted therapies in advanced HCC, opening new window to combined treatment in early-stage HCC.

hepatocellular carcinoma, TAE, cTACE, transarterial chemoembolization, treatment.