ART and science in using transarterial chemoembolization for retreating patients with hepatocellular carcinoma

Intermediate stage hepatocellular carcinoma (HCC) comprises of a highly heterogeneous patientpopulation, both in terms of liver function and tumour burden. Transarterial chemoembolization (TACE)is the treatment of choice for this subgroup of patients, provided that liver function is relatively preserved.Not all patients respond to an initial session of TACE, and further session might impair liver function. TheART score consists of an increase of AST 25%, increase of Child-Pugh of one or two points and absence ofradiological tumour response and helps identify patients that would not benefit from further TACE sessions.We critically appraise the use of this score, particularly in terms of patient selection and timing of calculationof its variables. Once sufficiently validated, it can become a safe, objective and accurate clinical tool ineveryday practice.