Chemoembolization with Drug Eluting Beads (TACE DEB) in patients with primary unresectable hepatocellular carcinoma (HCC)
Authors:
V. Třeška; P. Duras; H. Mírka; T. Skalický; O. Vyčítal; J. Brůha; J. Opatrný; V. Liška; A. Sutnar
Authors‘ workplace:
Radiodiagnostická klinika FN a LFUK v Plzni, přednosta: prof. MUDr. B. Kreuzberg, CSc.
; Chirurgická klinika FN a LFUK v Plzni, přednosta: Prof. MUDr. V. Třeška, DrSc.
Published in:
Rozhl. Chir., 2014, roč. 93, č. 2, s. 63-69.
Category:
Original articles
Práce podpořena Výzkumným záměrem P 36, UK v Praze.
Overview
Introduction:
The incidence of HCC is growing all over the word. Liver resection and transplantation are the methods of choice in only 25% of patients, representing radical treatment approaches. TACE is a method of palliative treatment in patients with primary unresectable disease.
Material and methods:
35 patients (27 men and 8 women) of an average age of 73.4 ± 7.2 years with HCC of average cumulative diameter 83.8 ± 36.3 mm were treated by TACE DEB with Doxorubicin. Solitary and multiple lesions were presented in 28 and 7 patients, respectively. 31 patients were classified as Child A, and 4 as Child B. One year overall survival, disease-specific, disease-free interval and their correlation with patients’ age, gender, as well as the number and cumulative diameter of tumours and complications after procedure were evaluated.
Results:
30-day mortality and morbidity rate was 0 and 8.6%, respectively. The so-called postembolization syndrome developed in 25.7% of patients. Repeated TACE was performed in 14 (40%) patients due to tumour progression. In two patients (5.7%) we performed liver resection after TACE. According to the RECIST criteria there was no complete response, partial response was presented in 17.1, stable disease in 37.1 and progression of disease in 25.7% of patients. One year overall survival, tumour-specific survival and disease-free survival was 69.7%, 88.9 and 49.3%, respectively. Better overall survival (p < 0.02) was achieved in patients < 75 years old. Worse disease-free interval was observed in patients with complication after TACE (p < 0.01). No significant differences were found in the other evaluated parameters.
Conclusion:
TACE is the method of palliative treatment in patients with unresectable HCC. There is no progression of HCC in one-half of patients after TACE. Better results are achieved in younger patients and in patients with no complications of procedure.
Key words:
hepatocellular carcinoma – TACE DEB – treatment results
Sources
1. Lewis AL, Gonzales V, Lloyd AW, et al. DC Bead™. In vitro characterization of a drug-delivery device for transarterial chemoembolization. J VascIntervRadiol 2006;17:335–342.
2. Hong K, Khwaja A, Liapi E, et al. New intra-arterial drug delivery system for the treatment of liver cancer: Pre-clinical assessment in a rabbit model of liver cancer. Clinical Cancer Research 2006;12:2563–2567.
3. Taylor RR, Tang Y, Gonzales V, et al. Irinotecan drug eluting beads for use in chemo-embolization: In Vitro and In vivo evaluation of drug release properties. European Journal of Pharmaceutical Sciences 2007;30:7–14.
4. Guan YS, He Q, Wang MQ. Transcatheter arterial chemoembolization: History for more than 30 years.ISRN Gastroenterology 2012;2:1–8.
5. Sato Y, Watanabe H, Sone M, Onaya H, Sakamoto N, et al. Tumor response evaluation criteria for HCC (hepatocellular carcinoma) treated using TACE (transcatheter arterial chemoembolization): RECIST (response evaluation criteria in solid tumors) version 1.1 and mRECIST (modified RECIST): JIVROSG-0602. Upsala J Med Sci 2013;118:16–22.
6. Kalva PS, Igbal SI, Yeddula K, Blaszkowsky LS, Akbar A, et al. Transarterial chemoembolization with Doxorubicin –eluting microspheres for inoperable hepatocellular carcinoma. Gastrointest Cancer Res 2011;4:2–8.
7. Hsu KF, Chu CH, Chan DC. Superselective transarterial chemoembolization vs hepatic resection for resectable early-stage hepatocellular carcinoma in patients with Child-Pugh class a liver function. Eur J Radiol 2011;81:466–471.
8. Chapman WC, Doyle MBM, Stuart JE. Outcomes of neoadjuvant transarterial chemoembolization to downstage hepatocellular carcinoma before liver transplantation. Ann Surg 2008;4;617–624.
9. Takayasu K, Arii S, Ikai I, Omata M, Okita K, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 2006;131:461–9.
10. Miyayama S, Yamashiro M, Okuda M, Yoshie Y, Sugimori N, et al. Chemoembolisation for the treatment of large Hepatocellular carcinoma. J Vasc Interv Radiol 2010;21:1226–34.
11. Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002;35: 1164–71.
12. Paul SB, Gamanagatti S, Sreenivas V, Chyndrashekhara SH, Mukund A, et al. Trans-arterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma: Experience from a tertiary care centre in India. Indian J Radiol Imaging 2011;21:113–120.
13. Malagari K, Pomoni M, Sotirchos VS, Moschouris H, Bouma E. Long-term recurrence analysis post drug eluting bead (DEB) chemoembolization for hepatocellular carcinoma. Hepato-Gastroenterology 2013;60:1413–1419.
14. Wang S, Zhuang L, Meng Z. Hepatocellular carcinoma more than 3 cm in diameter: A systematic review of transcatheter arterial chemoembolization plus percutaneous ethanol injection versus transcatheter arterial chemoembolization alone. Gastroenterology 2013;2:42–49.
15. Ni JY, Liu SS, Sun HL, Chen YT. Meta-analysis of radiofrequency ablation in combination with transarterial chemoembolization for hepatocellular carcinoma. WJS 2013;19:3872–3882.
16. Liao M, Huang J, Zhang T, Wu H. Transarterial chemoembolization in combination with local therapies for hepatocellular carcinoma: A meta-analysis. PLoS ONE 2013;8: e68453.
17. Zan SB, Li DF, Dong SI. Transcatheter arterial chemoembolization (TACE) combined with percutaneous ethanol injection (PEI) for the treatment of primary hepatocellular carcinoma (HCC). China Modern Doctor 2008;46:84–85.
18. Xu GH, Wen HC, Li ZW. Evaluation of hepatic chemoembolization and percutaneous ethanol injection in the treatment of HCC. Chinese J Radiol 2002;21:66–68.
19. Kubala E. Hepatocelulární karcinom – stávající možnosti léčby. Acta Medicinae 2013;8:79–81.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2014 Issue 2
Most read in this issue
- Evaluation of safe resection margins in tumours of parenchymatous organs
- Evaluation of safe resection margins in rectal carcinoma
- Evaluation of safe margins in pathology examination in breast oncosurgery
- Clostridium colitis at a surgical department