Medical Radiology and Radiation Safety. 2026. Vol. 71. № 3

DOI:10.33266/1024-6177-2026-71-3-122-127

A.A. Zavialov, M.V. Popov, V.A. Melkumyan, N.A. Ponomarev, V.S. Rudakov, A.N. Bashkov, S.E. Voskanyan

The Prospects of Transarterial Chemoembolization for Patients with Hepatocellular Carcinoma on the Waiting List for Transplantation Using the Bridge-Therapy Principle Taking Into Account the Drop-Out Problem: a Literature Review

A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia

Contact person: V.A. Melkumyan, e-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра.

 

Abstract

Purpose: The article is devoted to the generalization of material on the study of the role of transarterial chemoembolization (TACE) within the framework of  the concept of bridge-therapy for patients with hepatocellular carcinoma awaiting liver transplantation, with emphasis on the prevention of drop-out and improvement of long-term results.

Material and methods: The study is based on the analysis of modern scientific data on the use prospects for the use of bridge-therapy TACE, taking into account the drop-out problem. The method of systematic literature review with an assessment of the clinical results of various TACE techniques was used. The search for information sources was carried out in PubMed, Google Scholar. The horizon of literature data research was 10 years. When systematizing the material, preference was given to scientific works published in the period 2020–2025.

Results: The analysis showed that, thanks to the transarterial chemoembolization method using the “bridge therapy” principle,patients with hepatocellular carcinoma of the liver remain on the transplant waiting list without experiencing drop-out. Thus,this method (TACE) provides improved treatment outcomes: increased survival and improved quality of live.

Conclusions: Thus, to date, TACE is the optimal bridge-therapy for patients with HCC awaiting liver transplantation. The method reduces the drop-out rate, improves the tumor’s morphological response, and significantly contributes to the overall effectiveness of the transplantation program.

Keywords:  hepatocellular carcinoma, endovascular treatment, transarterial chemoembolization,  drug-saturated microspheres, bridge-therapy, drop-out

For citation:  Zavialov AA, Popov MV, Melkumyan VA, Ponomarev NA, Rudakov VS, Bashkov AN, Voskanyan SE. The Prospects of Transarterial Chemoembolization for Patients with Hepatocellular Carcinoma on the Waiting List for Transplantation Using the Bridge-Therapy Principle Taking Into Account the Drop-Out Problem: a Literature Review. Medical Radiology and Radiation Safety. 2026;71(3):122–127. DOI:10.33266/1024-6177-2026-71-3-122-127

 

References

1.Sequeira L.M., Ozturk N.B., Sierra L., et al. Hepatocellular Carcinoma and the Role of Liver Transplantation: an Update and Review. J Clin Transl Hepatol. 2025;13;4:327-338. Doi: 10.14218/JCTH.2024.00432.

2.Зогот С.Р., Акберов Р.Ф., Зыятдинов К.Ш., Варшавский Ю.В. Гепатоцеллюлярный рак (эпидемиология, лучевая диагностика, современные аспекты лечения) // Практическая медицина. 2013. Т.2. №67. С. 112-115 [Zogot S.R., Akberov R.F., Zyyatdinov K.Sh., Varshavskiy Yu.V. Hepatocellular Cancer (Epidemiology, Radiation Diagnostics, Modern Aspects of Treatment). Prakticheskaya Meditsina = Practical Medicine. 2013;2;67:112-115 (In Russ.)].

3.Bray F., Ferlay J., Soerjomataram I., Siegel R.L., Torre L.A., Jemal A. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2018;68;6:394-424. Doi: 10.3322/caac.21492.

4.Konyn P., Ahmed A., Kim D. Current Epidemiology in Hepatocellular Carcinoma. Expert Rev Gastroenterol Hepatol. 2021;15;11:1295-1307. Doi: 10.1080/17474124.2021.1991792.

5.Шпангенберг Х.Ц., Тимме Р. Гепатоцеллюлярная карцинома // Медицинский совет. 2011. №9-10. С.112-115 [Shpangenberg Kh.Ts., Timme R. Hepatocellular Carcinoma. Meditsinskiy Sovet = Medical Council. 2011;9-10:112-115 (In Russ.)].

6.Lerut J., Iesari S., et al. Hepatocellular Cancer and Liver Transplantation: Necessity to Go from Chaos to Order. Alm Clin Med. 2018;46;6:552-559. Doi: 10.18786/2072-0505-2018-46-6-552-559.

7.Muhammad H., Tehreem A., Ting P.S., et al. Hepatocellular Carcinoma and the Role of Liver Transplantation: a Review. J Clin Transl Hepatol. 2021;9;5:738-748. Doi: 10.14218/JCTH.2021.00125.

8.Власова Н.А., Апанасевич В.И., Елисеева Е.В., Старцев С.С., Невожай В.И. Эволюция подходов к лечению гепатоцеллюлярной карциномы // Тихоокеанский Медицинский журнал. 2025.№ 2. С. 24-32 [Vlasova N.A., Apanasevich V.I., Yeliseyeva Ye.V., Startsev S.S., Nevozhay V.I. Evolution of Approaches to the Treatment of Hepatocellular Carcinoma. Tikhookeanskiy Meditsinskiy Zhurnal = Pacific Medical Journal. 2025;2:24-32 (In Russ.)]. Doi: 10.34215/1609-1175-2025-2-24-32.

9.Новрузбеков М.С., Олисов О.Д. К вопросу о трансплантации печени у больных гепатоцеллюлярной карциномой (краткий обзор литературы) // Злокачественные опухоли. 2016. Т.4S1. №21. С. 36-39 [Novruzbekov M.S., Olisov O.D. On the Issue of Liver Transplantation in Patients with Hepatocellular Carcinoma (a Brief Review of the Literature). Zlokachestvennyye Opukholi = Malignant Tumors. 2016;4S1;21:36-39 (In Russ.)]. Doi: 10.18027/2224-5057-2016-4s1-36-39.

10.Бредер В.В., Джанян И.А., Питкевич М.Ю., и др. Трансартериальная химиоэмболизация в лечении больных локализованным неоперабельным гепатоцеллюлярным раком: отдаленные результаты и факторы прогноза // Вопросы онкологии. 2018. Т.64. №6. С. 793-798 [Breder V.V., Dzhanyan I.A., Pitkevich M.Yu., et al. Transarterial Chemoembolization in the Treatment of Patients with Localized Inoperable Hepatocellular Carcinoma: Long-Term Results and Prognostic Factors. Voprosy Onkologii = Problems in Oncology. 2018;64;6:793-798 (In Russ.)]. 

11.Чекунов Д.А., Поляков Р.С., Багмент Н.Н., Мойсюк Ю.Г., Федоров Д.Н., Скипенко О.Г. Трансартериальная терапия гепатоцеллюлярного рака // Хирургия. Журнал им. Н.И. Пирогова. 2015. №9. С. 43-49 [Chekunov D.A., Polyakov R.S., Bagment N.N., Moysyuk YU.G., Fedorov D.N., Skipenko O.G. Transarterial Therapy of Hepatocellular Carcinoma. Khirurgiya. Zhurnal im. N.I. Pirogova = Surgery. Journal named after N.I. Pirogov. 2015;9:43-49 (In Russ.]. Doi: 10.17116/hirurgia2015943-49.

12.Погребняков И.В. Стандарты проведения процедуры трансартериальной химиоэмболизации при лечении пациентов с гепатоцеллюлярной карциномой: обзор литературы. Часть 1 // Онкологический журнал: лучевая диагностика, лучевая терапия. 2024. Т.7. №2. С. 63-75 [Pogrebnyakov I.V. Standards for the Transarterial Chemoembolization Procedure in the Treatment of Patients with Hepatocellular Carcinoma: a Literature Review. Part 1. Onkologicheskiy Zhurnal Luchevaya Diagnostika Luchevaya Terapiya = Journal of Oncology: Diagnostic Radiology and Radiotherapy. 2024;7;2:63-75 (In Russ.)]. Doi: 10.37174/2587-7593-2024-7-2-63-75.

13.Виршке Э.Р., Косырев В.Ю., Долгушин Б.И. Гепатоцеллюлярный рак, BCLC b: в поисках оптимального лечения. Интервенционные радиологические технологии в лечении больных ГЦР // Злокачественные опухоли. 2016. Спецвыпуск 1. С. 26-28 [Virshke E.R., Kosyrev V.Yu., Dolgushin B.I. Hepatocellular Carcinoma, BCLC b: in Search of Optimal Treatment. Interventional Radiological Technologies in the Treatment of Patients with HCC. Zlokachestvennyye Opukholi = Malignant Tumors. 2016;Special Issue 1:26-28. (In Russ.)].

14.Готье С.В., Хомяков С.М. Донорство и трансплантация органов в Российской Федерации в 2023 году. XVI сообщение регистра Российского трансплантологического общества // Вестник трансплантологии и искусственных органов. 2024. Т.26. №3. С. 8-31 [Got’ye S.V., Khomyakov S.M. Organ Donation and Transplantation in the Russian Federation in 2023. XVI Message of the Registry of the Russian Transplantation Society. Vestnik Transplantologii i Iskusstvennykh Organov = Russian Journal of Transplantology and Artificial Organs. 2024;26;3:8-31 (In Russ.)]. Doi: 10.15825/1995-1191-2024-3-8-31

15.Mehta N., Dodge J.L., Grab J.D., Yao F.Y. National Experience on Down-Staging of Hepatocellular Carcinoma Before Liver Transplant: Influence of Tumor Burden, Alpha-Fetoprotein, and Wait Time. Hepatol Baltim Md. 2020;71;3:943-954. Doi: 10.1002/hep.30879.

16.Soin A.S., Bhangui P., Kataria T., et al. Experience with LDLT in Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombosis Postdownstaging. Transplantation. 2020;104;11:2334-2345. Doi: 10.1097/TP.0000000000003162.

17.Seinstra B.A., Defreyne L., Lambert B., et al. Transarterial Radioembolization Versus Chemoembolization for the Treatment of Hepatocellular Carcinoma (TRACE): Study Protocol for a Randomized Controlled Trial. Trials. 2012;13;1:144. Doi: 10.1186/1745-6215-13-144.

18.Huh S.J., Wu H.G., Ahn Y.C., et al. Why do Patients Drop out during Radiation Therapy?:  Analyses of Incompletely Treated Patients. J Korean Soc Ther Radiol Oncol. 1998;16;3:347-350.

19.European Association for the Study of the Liver. Liver EA for the S of the Cancer EO for R and T of EASL–EORTC Clinical Practice Guidelines: Management of Hepatocellular Carcinoma. J Hepatol. 2012;56;4:908-943. Doi: 10.1016/j.jhep.2011.12.001.

20.Bell M.L., Kenward M.G., Fairclough D.L., Horton N.J. Differential Dropout and Bias in Randomised Controlled Trials: When it Matters and When it May Not. BMJ. 2013;346:e8668. Doi: 10.1136/bmj.e8668.

21.Trieu J.A, Bilal M., Hmoud B. Factors Associated with Waiting Time on the Liver Transplant List: an Analysis of the United Network for Organ Sharing (UNOS) Database. Ann Gastroenterol. 2018;31;1:84-89. Doi: 10.20524/aog.2017.0217.

22.Heimbach J.K., Kulik L.M., Finn R.S., et al. AASLD Guidelines for the Treatment of Hepatocellular Carcinoma. Hepatol Baltim Md. 2018;67;1:358-380. Doi: 10.1002/hep.29086.

23.Ponniah S.A., Zori A.G., Cabrera R. Locoregional Therapies for Bridging and Downstaging Hepatocellular Carcinoma Prior to Liver Transplant. Ed. Sergi CM. Liver Cancer. Exon Publications, 2021. URL: http://www.ncbi.nlm.nih.gov/books/NBK569804/. (Date of Access January 10, 2026).

24.Попов М.В., Аронов М.С., Восканян С.Э., Карпова О.В. Методика трансартериальной химиоэмболизации при первичных и метастатических опухолях печени // Саратовский научно-медицинский журнал. 2016. Т.12. №4. С. 716-720 [Popov M.V., Aronov M.S., Voskanyan S.E., Karpova O.V. Methodology of Transarterial Chemoembolization for Primary and Metastatic Liver Tumors. Saratovskiy Nauchno-Meditsinskiy Zhurnal = Saratov Journal of Medical Scientific Research. 2016;12;4:716-720 (In Russ.)]. URL: https://elibrary.ru/item.asp?id=29243323 (Date of Access January 20, 2022).

25.Maddala Y.K., Stadheim L., Andrews J.C., et al. Drop-out Rates of Patients with Hepatocellular Cancer Listed for Liver Transplantation: Outcome with Chemoembolization. Liver Transplant off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2004;10;3:449-455. Doi: 10.1002/lt.20099.

26.Anwanwan D., Singh S.K., Singh S., Saikam V., Singh R. Challenges in Liver Cancer and Possible Treatment Approaches. Biochim Biophys Acta Rev Cancer. 2020;1873;1:188314. Doi: 10.1016/j.bbcan.2019.188314.

27.Couri T., Pillai A. Goals and Targets for Personalized Therapy for HCC. Hepatol Int. 2019;13;2:125-137. Doi: 10.1007/s12072-018-9919-1.

28.Liu H.Y.H., Lee Y.Y.D., Sridharan S., et al. Definitive Stereotactic Body Radiation Therapy in Early-Stage Solitary Hepatocellular Carcinoma: an Australian Multi-Institutional Review of Outcomes. Clin Oncol R Coll Radiol G B. 2023;35;12:787-793. Doi: 10.1016/j.clon.2023.08.012.

29.Agopian V.G., Harlander-Locke M.P., Ruiz R.M., et al. Impact of Pretransplant Bridging Locoregional Therapy for Patients with Hepatocellular Carcinoma within Milan Criteria Undergoing Liver Transplantation: Analysis of 3601 Patients from the US Multicenter HCC Transplant Consortium. Ann Surg. 2017;266;3:525-535. Doi: 10.1097/SLA.0000000000002381

30.Kostakis I.D., Dimitrokallis N., Iype S. Bridging Locoregional Treatment Prior to Liver Transplantation for Cirrhotic Patients with Hepatocellular Carcinoma within the Milan Criteria: a Systematic Review and Meta-Analysis. Ann Gastroenterol. 2023;36;4:449-458. Doi: 10.20524/aog.2023.0812.

31.Tan C.H.N., Yu Y., Tan Y.R.N., et al. Bridging Therapies to Liver Transplantation for Hepatocellular Carcinoma: a Bridge to Nowhere? Ann Hepato-Biliary-Pancreat Surg. 2018;22;1:27-35. Doi: 10.14701/ahbps.2018.22.1.27.

32.Clavien P.A., Lesurtel M., Bossuyt P.M.M., et al. Recommendations for Liver Transplantation for Hepatocellular Carcinoma: an International Consensus Conference Report. Lancet Oncol. 2012;13;1:e11-22. Doi: 10.1016/S1470-2045(11)70175-9.

33.European Association for the Study of the Liver, European Organization for Research and Treatment of Cancer. EASL-EORTC Clinical Practice Guidelines: Management of Hepatocellular Carcinoma. J Hepatol. 2012;56;4:908-943. Doi: 10.1016/j.jhep.2011.12.001.

34.Claasen M.P.A.W., Sneiders D., Rakké Y.S., et al. European Society of Organ Transplantation (ESOT) Consensus Report on Downstaging, Bridging and Immunotherapy in Liver Transplantation for Hepatocellular Carcinoma. Transpl Int Off J Eur Soc Organ Transplant. 2023;36:11648. Doi: 10.3389/ti.2023.11648.

35.Dolphin J., Zubillaga J., Jamal Q.M., et al. Optimizing Transarterial Chemoembolization in Hepatocellular Carcinoma: Current Strategies, Innovations, and Future Directions. Cureus. 2025;17;10:e95128. Doi: 10.7759/cureus.95128.

36.Kim D.S., Yoon Y.I., Kim B.K., et al. Asian Pacific Association for the Study of the Liver Clinical Practice Guidelines on Liver Transplantation. Hepatol Int. 2024;18;2:299-383. Doi: 10.1007/s12072-023-10629-3.

37.Renner P., Da Silva T., Schnitzbauer A.A., Verloh N., Schlitt H.J., Geissler E.K. Hepatocellular Carcinoma Progression during Bridging before Liver Transplantation. BJS Open. 2021;5;2:zrab005. Doi: 10.1093/bjsopen/zrab005.

38.Lim W.X., Sim K.S., Chen C.L., Ou H.Y., Yu C.Y., Cheng Y.F. Drug-Eluting Bead Transarterial Chemoembolization for Hepatocellular Carcinoma: the Effectiveness of Different Particle Sizes in Downstaging and Bridging in Living Donor Liver Transplantation. Transplant Proc. 2024;56;3:596-601. Doi: 10.1016/j.transproceed.2024.01.062.

39.Parikh N.D., Waljee A.K., Singal A.G. Downstaging Hepatocellular Carcinoma: A systematic Review and Pooled Analysis. Liver Transplant off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2015;21;9:1142-1152. Doi: 10.1002/lt.24169.

40.Mehta N., Dodge J.L., Grab J.D., Yao F.Y. National Experience on Down-Staging of Hepatocellular Carcinoma before Liver Transplant: Influence of Tumor Burden, Alpha-Fetoprotein, and Wait Time. Hepatol Baltim Md. 2020;71;3:943-954. Doi: 10.1002/hep.30879.

41.Vitale A., Scolari F., Bertacco A., et al. Sustained Complete Response after Biological Downstaging in Patients with Hepatocellular Carcinoma: XXL-Like Prioritization for Liver Transplantation or “Wait and See” Strategy? Cancers. 2021;13;10:2406. Doi: 10.3390/cancers13102406.

42.Ravaioli M., Odaldi F., Cucchetti A., et al. Long Term Results of Down-Staging and Liver Transplantation for Patients with Hepatocellular Carcinoma Beyond the Conventional Criteria. Sci Rep. 2019;9;1:3781. Doi: 10.1038/s41598-019-40543-4.

43.Affonso B.B., Galastri F.L., da Motta Leal Filho J.M., et al. Long-Term Outcomes of Hepatocellular Carcinoma that Underwent Chemoembolization for Bridging or Downstaging. World J Gastroenterol. 2019;25;37:5687-5701. Doi: 10.3748/wjg.v25.i37.5687.

44.Fan W., Guo J., Zhu B., et al. Drug-Eluting Beads TACE is Safe and Non-Inferior to Conventional TACE in HCC Patients with TIPS. Eur Radiol. 2021;31;11:8291-8301. Doi: 10.1007/s00330-021-07834-9.

45.Geschwind J.F., Kudo M., Marrero J.A., et al. TACE Treatment in Patients with Sorafenib-Treated Unresectable Hepatocellular Carcinoma in Clinical Practice: Final Analysis of GIDEON. Radiology. 2016;279;2:630-640. Doi: 10.1148/radiol.2015150667.

46.Geschwind J.F., Kudo M., Marrero J., et al. Final Analysis of GIDEON (Global Investigation of Therapeutic Decisions in Hepatocellular Carcinoma and of its Treatment with SorafeNib): Regional Trends, Safety, and Outcomes in Patients Receiving Concomitant Transarterial Chemoembolization. Chicago, 31 May – 4 June 2013. Chicago, American Society of Clinical Oncology (ASCO), 2013.

47.Alim A., DuBay D. The Role of Radiological Interventions in Hepatocellular Carcinoma before Liver Transplantation: a Surgical Perspective. Front Surg. 12:1594579. Doi: 10.3389/fsurg.2025.1594579.

48.Forner A., Gilabert M., Bruix J., Raoul J.L. Treatment of Intermediate-Stage Hepatocellular Carcinoma. Nat Rev Clin Oncol. 2014;11;9:525-535. Doi: 10.1038/nrclinonc.2014.122.

49.Raoul J.L., Sangro B., Forner A., et al. Evolving Strategies for the Management of Intermediate-Stage Hepatocellular Carcinoma: Available Evidence and Expert Opinion on the Use of Transarterial Chemoembolization. Cancer Treat Rev. 2011;37;3:212-220. Doi: 10.1016/j.ctrv.2010.07.006.

 

 

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Conflict of interest. The authors declare no conflict of interest.

Financing. The study had no sponsorship.

Contribution. The article was prepared by one author.

Article received: 20.02.2026. Accepted for publication: 25.03.2026.