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.