408 The Korean Journal of Hepatology Vol. 16. No. 4, December 2010 approach to the lesion is clinically challenging. For these reasons, reported that cumulative local recurrence rate after subsegmental prognosis of caudate HCC is relatively poor.5 TACE for caudate HCC was very high compared with recurrence Surgical resection has been generally regarded as curative rate after subsegmental TACE for HCC in the other segments, method for HCC. Although HCC in caudate lobe is rare, and technical success rate of the procedure was relatively low resection would be the most effective treatment and provide long-term survival.6 Recently, improvement in surgical technique (around 70%).19 In previous study that analyzed explants after pre-transplant conventional TACE, a total or at least subtotal enables successful resection of caudate HCC, however, several necrosis (≥ 80%) was noted in 30% on the liver explants, and half operative risks and HCC recurrence are still remained problems.7-10 of the explants showed tumor necrosis less than 50%.20 However, As an alternative treatment modality, radiofrequency ablation experimental study has shown that complete tumor destruction was conducted to treat caudate HCC by several methods, i.e. was observed in the DEB-treated animals sacrificed 7 days after conventional percutaneous, laparoscopy-assisted, or intra-operative approaches.11-13 But the proximity to major vessels contains treatment.3 It means that DEB could be a potential curative therapeutic modality for HCC if there is no problem regarding potential risk of complication and incomplete ablation related embolization procedures. with heat sink effect. We report a case of caudate HCC successfully treated with In this case, patient’s stage according to BCLC criteria was DEB-TACE. TACE using this new agent could be an alternative early, proposed to be treated effectively by resection, liver therapy or downstaging method for the caudate HCC patients transplantation or ablation.1 Although TACE was not suitable as who are not eligible to conventional treatment including surgical first-line therapy for such an early-staged patient, TACE can be resection. performed in patients at the early stage in whom ablation cannot be performed because of tumor location or medical comorbidities.1 By reason of aforementioned treatment limitations and patient’s refusal of surgery TACE using DEB was performed, and as a result, therapeutic response was satisfying without any serious complications. DEB are a new soft deformable device of spherical shape composed by a polyvinyl alcohol and a hydrophilic monomer that can be loaded with anthracycline derivatives such as doxorubicin.14 So, drug-loaded beads can be delivered intra- arterially into the tumor and elute the chemotherapeutic effect.3 Previous studies have shown that TACE with DEB results in promising efficacy and low toxicity.15-17 Post-embolization syndrome, cholecystitis, liver abscess, and skin rash were reported as procedure-related complications.17 In recent European multicenter comparative study, 212 patients with Child-Pugh A/B cirrhosis and large and/or multinodular, unresectable HCC (BCLC classification A or B) were randomized to receive either conventional TACE or DEB-TACE. According to the per- protocol analysis, objective response rate in the DEB-TACE group was 52%. In subgroup analysis, patients with more advanced disease-defined as Child-Pugh stage B, Eastern Cooperative Oncology Group performance status 1, bilobular or recurrent disease-had a significantly greater objective response rate (53%) in the DEB-TACE group.18 We cannot assert the efficacy if the patient underwent conventional TACE instead of DEB-TACE. Terayama et al Acknowledgements The authors have nothing to disclose regarding funding or conflict of interest with respect to this manuscript. REFERENCES 1. El-Serag HB, Marrero JA, Rudolph L, Reddy KR. Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology 2008;134: 1752-1763. 2. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 2003;37:429-442. 3. Hong K, Khwaja A, Liapi E, Torbenson MS, Georgiades CS, Geschwind JF. 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