Different Protocols for Repeated Transarterial Chemoembolization in the Treatment of Patients With Hepatocellular Carcinoma

Inclusion Criteria:

* Patients with histologically confirmed HCC with unresectable disease without extrahepatic metastases;
* HCC with no previous treatment;
* age between 18 and 75 years;
* Life expectancy of at least 8 weeks;
* main tumor size greater than 5 cm;
* adequate hematologic function (platelet count: \>60 × 109 platelets/L; hemoglobin: \>90g/L; and prothrombin time: \<3 seconds above control);
* adequate renal function (serum creatinine: ≤1.5 × upper limit of normal);
* Child-Pugh classification A or B grade;
* Barcelona Clinic Liver Cancer (BCLC) stage B or C;
* Eastern Co-operative Group performance status of zero or one.

Exclusion Criteria:

* a hypovascular tumor (defined as a tumor with all its parts less contrast-enhanced than the nontumorous liver parenchyma on arterial phase computed tomography scans);
* diffuse-type HCC;
* evidence of hepatic decompensation including esophageal or gastric variceal bleeding or hepatic encephalopathy;
* severe underlying cardiac or renal diseases;
* color Doppler ultrasonography showing portal vein tumor thrombosis with complete main portal vein obstruction without cavernous transformation; or obstructive jaundice.