Advanced-stage hepatocellular carcinoma with portal vein thrombosis: conventional versus drug-eluting beads transcatheter arterial chemoembolization

Abstract

Objectives Our study sought to compare the overall survival in patients with hepatocellular carcinoma (HCC) and portal venous thrombosis (PVT), treated with either conventional trans-arterial chemoembolization (cTACE) or drug-eluting beads (DEB) TACE. Methods This retrospective analysis included a total of 133 patients, treated without cross-over and compared head-to-head by means or propensity score weighting. Mortality was compared using survival analysis upon propensity score weighting. Adverse events and liver toxicity grade ≥3 were recorded and reported for each TACE. In order to compare with historical sorafenib studies, a sub-group analysis was performed and included patients who fulfilled the SHARP inclusion criteria. Results The median overall survival (MOS) of the entire cohort was 4.53 months (95 % CI, 3.63–6.03). MOS was similar across treatment arms, no significant difference between cTACE (N =95) and DEB-TACE (N =38) was observed (MOS of 5.0 vs. 3.33 months, respectively; p = 0.157). The most common adverse events after cTACE and DEB- TACE, respectively, were as follows: post-embolization syndrome [N =57 (30.0 %) and N =38 (61.3 %)], diarrhea [N =3 (1.6 %) and N =3 (4.8 %)], and encephalopathy [N =11 (5.8 %) and N=2 (3.2 %)]. Conclusion Our retrospective study could not reveal a difference in toxicity and efficiency between cTACE and DEB-TACE for treatment of advanced stage HCC with PVT.

Congenital absence of the portal vein complicated by hepatocellular carcinoma in the liver of an adult woman: review of imaging, literature and management

“…However, PV thrombosis does portend a poorer prognosis [24] . As anticipated post embolization syndrome is the most common side effect reported post TACE, while encephalopathy was found in approximately 5% of patients, and elevated liver function tests as high as 20% of cases [23] . In a comparison, c-TACE and drug eluting bead TACE had similar safety profiles and survival rates comparable to treatment with sorafenib [23] .…”

“…As anticipated post embolization syndrome is the most common side effect reported post TACE, while encephalopathy was found in approximately 5% of patients, and elevated liver function tests as high as 20% of cases [23] . In a comparison, c-TACE and drug eluting bead TACE had similar safety profiles and survival rates comparable to treatment with sorafenib [23] . The use of AFP as an oncologic marker of response to loco-regional therapy for HCC has been proven to be effective [25] .…”

“…In this case, c-TACE had already been performed at an outside facility. TACE has been shown to be safe and effective in patients with advanced or BCLC C disease which includes patients with varying degrees of PV thrombosis [23,24] . However, PV thrombosis does portend a poorer prognosis [24] .…”

<p>Comparison of chemoembolization with CalliSpheres® microspheres and conventional chemoembolization in the treatment of hepatocellular carcinoma: a multicenter retrospective study</p>

“…revealed that there was no difference regarding the median OS in advanced HCC patients with portal vein thrombosis treated by DEB-TACE with LC bead ® and patients treated by cTACE. 16 However, a retrospective cohort study conducted by Rahman et al elucidateed that in unresectable HCC patients, DEB-TACE presented with a more prolonged median survival time compared with cTACE. 17 Furthermore, a meta-analysis demonstrated that the 1 year, 2 year and 3 year survival rates were elevated in HCC patients treated by DEB-TACE compared with cTACE, and the 1 year-as well as 2 year-relapse-free survival rates were also increased in patients treated with DEB-TACE.…”

Recent advances in medical management of hepatocellular carcinoma

“…Among 16 articles that retrospectively analyzed DEB‐TACE versus cTACE, five described the superiority of DEB‐TACE, three showed an advantage of cTACE, and the remaining eight showed equivalent effect or adverse events. Individual evaluation of objective response rate, TTP, OS, and adverse events, did not show definite advantages of DEB‐TACE over cTACE in these retrospective studies.…”