Abstract Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer, which is the third-leading cause of cancer deaths worldwide. Recent updates in the Barcelona Clinic Liver Cancer (BCLC) guidelines have expanded the role of locoregional therapies to include transarterial radioembolization (TARE) along with transarterial chemoembolization (TACE) and thermal ablation. However, the selection and timing of each locoregional therapy remain a complex decision. An available approach is the combination of TACE with thermal ablation (TACE–ablate). The goal of this review is to assess the existing literature on the use of TACE–ablate for HCC. Overall, there is a suggestion of benefit in overall and progression-free survival for HCC >3 cm compared with ablation or TACE alone. Current evidence suggests ablation monotherapy is effective for tumors <3 cm while ablative-intent TARE is effective for tumors as large as 8 cm, though the median tumor size in key studies is <3 cm. The data for TACE–ablate in tumors <3 cm is mixed though it remains an option for patients with contraindications to ablation or ablative-intent radioembolization.
Datta et al. (Mon,) studied this question.