Comparison of Response and Outcomes of Drug-eluting Bead Chemoembolization (DEB-TACE) Versus Radioembolization (TARE) for Patients With Colorectal Cancer Liver Metastases

Abstract

Background: To compare outcomes for patients with colorectal cancer liver metastases (CRCLM) treated by drug-eluting bead chemoembolization (DEB-TACE) or radioembolization (TARE). Patients and Methods: A singlecenter retrospective review was carried out on 202 patients with CRCLM, treated by or TARE (n=155) patients. Propensity-matching yielded 44 pairs. Paired statistical analysis was performed on matched pair demographics, treatment response, and survival. Results: Patients treated with DEB-TACE had worse extra-hepatic metastasis (68.1 vs. 47.7%, p=0.014) and ≥10 liver lesions (42.2 vs. 68.8%, p=0.001). Matched patients treated with DEB-TACE had a trend towards worse toxicity (27% vs. 9.1% (p=0.057). Index DEB-TACE treatment was not a prognostic factor for overall survival (hazard ratio=0.94, 95% confidence intervaI=0.54-1.65; p=0.83). Conclusion: In the matched CRCLM cohort, there was a trend towards worse toxicity post-DEB-TACE treatment, but it was not an independent prognostic factor for survival.Metastatic colon cancer is one of the leading causes for colon cancer-driven morbidity and mortality (1). Treatment for colorectal cancer liver metastases (CRCLM) includes hepatectomy with curative intent along with systemic chemotherapy and biological agents (such as bevacizumab, or cetuximab) (1). Treatment can become more challenging for patients who are not candidates for surgery or who have failed multiple lines of systemic therapy.Transarterial liver therapy can be used to mitigate liver disease and has been shown to achieve good tumor response and disease control in large cohorts (2, 3). Transarterial radioembolization (TARE) involves the infusion of glass (Theraspere; BTG Company), London, UK) or resin (SirSpheres, Sirtex, North Sydney, NSW, Australia) microspheres carrying yttrium-90, a radioactive element that emits pure beta-particle radiation, into liver tumors through their hepatic arterial feeding vessels (4). Chemoembolization (TACE) is another treatment modality that shuts down tumor blood flow, promotes necrosis, and releases chemotherapy (5). TACE with drug-eluting beads (DEB-TACE) has been developed to optimize chemotherapy and embolic particle delivery including via delivery of calibrated bead size and longer sustained chemotherapy release (3).While there are clinical studies suggesting that TARE and DEB-TACE separately have treatment effectiveness against CRCLM (6-15), there are very limited studies comparing TARE and DEB-TACE toxicity and treatment response in patients with CRCLM (16,17). This study compared the treatment response, toxicity, and survival for patients with CRCLM treated with DEB-TACE or TARE. Patients and MethodsThe study protocol conformed to the 1975 Declaration of Helsinki ethical guidelines and had Institutional Review Board approval (IRB ID#: 201608028). The study was a retrospective analysis of singleinstitution patients who underwent transarterial treatment for CRCLM. Key demographics included age, gender, sex, weight, baseline medical history (cardiac, vascular, pulm...

Transarterial Chemoembolization in Treatment-Naïve and Recurrent Hepatocellular Carcinoma: A Propensity-Matched Outcome and Risk Signature Analysis

“…In this study, the symptoms of patients with biloma and liver abscess were gradually improved after percutaneous drainage. Similar to other studies ( 30 – 33 ), postembolism syndrome such as fever, vomiting, and abdominal pain were the most common complications in the current study, and most of them are self-limiting.…”

Morphology, Loadability, and Releasing Profiles of CalliSpheres Microspheres in Delivering Oxaliplatin: An In Vitro Study

“…Furthermore, we also observed that FBS had no effect on the releasing profiles of oxaliplatin-loaded CSM, which provides more support for Such as irinotecan-eluting microspheres, although exhibit rapid release profile, is widely used to treat liver metastases of colorectal cancer. 38,39 As to morphology of DEB before and after drug loading, a previous study illuminates that DC beads and HSM are both found to be less smooth and less regularly shaped after doxorubicin or irinotecan loading, and they are shrunken after doxorubicin or irinotecan loading and recovered to almost original sizes after elution. 12,40 While no report has been reported on the morphology of DEB before and after oxaliplatin loading.…”

“…Such as irinotecan-eluting microspheres, although exhibit rapid release profile, is widely used to treat liver metastases of colorectal cancer. 38,39…”

Efficacy of Drug-Eluting Bead Transarterial Chemoembolization in the Treatment of Colorectal Cancer Liver Metastasis

“…As a result, the embolization effect is not satisfactory. Drug-eluting bead (DEB) embolization uses a new type of drug-loaded microspheres that can continuously kill tumors by slowly releasing drugs [ 6 , 7 ]. Studies have proved that DEB embolization shows a good treatment effect for metastatic liver cancer [ 8 , 9 ].…”