Complete response at first chemoembolization is still the most robust predictor for favorable outcome in hepatocellular carcinoma

Kim, Seung Up; Kim, Kyung-Ah; Chung, Yong Eun; Park, Mi-Suk; Park, Jun Yong; Kim, Do Young; Ahn, Sang Hoon; Kim, Man Deuk; Park, Sung Il; Won, Jong Yun; Lee, Do Yun; Han, Kwang‐Hyub

doi:10.1016/j.jhep.2015.01.022

Cited by 169 publications

(171 citation statements)

References 35 publications

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“…In particular, 1-year survival rate of our patients was higher than in most other studies reported in the literature, while 2-year survival was only marginally lower than the results reported by Iwazawa et al ., where cTACE was also performed under CBCT control (2-year survival, 81%) 21 . The high 1-year OS reported in our study may be related to the high objective response rates achievable with DEBDOX TACE, supported by the fact that objective response to treatment correlates with prolonged OS 30 . In addition, the most common reason for death in our study was not related to progression of HCC but rather to liver cirrhosis, which may explain the significant drop in 2-year survival.…”

Section: Discussionmentioning

confidence: 55%

Survival of patients with intermediate stage hepatocellular carcinoma treated with superselective transarterial chemoembolization using doxorubicin-loaded DC Bead under cone-beam computed tomography control

Popovič

Štabuc

Janša

et al. 2016

Radiology and Oncology

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BackgroundThe purpose of this retrospective study was to evaluate treatment response, adverse events and survival rates of patients with intermediate stage HCC treated with superselective doxorubicin-loaded DC Bead transarterial chemoembolization (DEBDOX) under cone beam computed tomography (CBCT) control.Patients and methodsBetween October 2010 and June 2012, 35 consecutive patients with intermediate stage HCC (32 male, 3 female; average age, 67.5 ± 7.8 years; 22 patients Child-Pugh class A, 8 class B, 5 without cirrhosis) were treated with DEBDOX TACE. Portal vein thrombosis was observed in 6 (17.1%) patients. DEBDOX TACE was performed by superselective catheterization of feeding vessels followed by embolization with 100-300 μm microspheres loaded with 50-100 mg of doxorubicin. In all cases, CBCT was used during chemoembolization. Tumor response rates were defined according to mRECIST criteria.ResultsOverall, 120 procedures were performed (mean, 3.2 per patients). We treated 97 lesions with an average diameter of 4.9 ± 1.9 cm. There were 32 minor and 2 (1.6%) major complications (one liver abscess and one cerebrovascular insult). After a mean follow-up of 27.7 ± 10.5 months, 94.3% of patients achieved an objective response to treatment (42.4% complete response and 57.6% partial response). Mean time to progression was 10.9 ± 5.3 months. Mean overall survival was 33.9 months (95% CI; 28.9 – 38.9 months), with 1- and 2- year survival of 97.1% and 65.7%, respectively.ConclusionsSuperselective DEBDOX TACE performed under CBCT control is a safe and effective method with high rates of tumor response and overall survival.

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Section: Discussionmentioning

confidence: 55%

Survival of patients with intermediate stage hepatocellular carcinoma treated with superselective transarterial chemoembolization using doxorubicin-loaded DC Bead under cone-beam computed tomography control

Popovič

Štabuc

Janša

et al. 2016

Radiology and Oncology

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“…In this study, patients treated with CCRT had larger tumors but significantly better PFS and OS than those with TACE. Given that the response to the initial treatment is a strong predictor for clinical outcome (27), CCRT seems promising for intermediate-to-advanced HCCs with increased 18 F-FDG uptake. Recently, multimodality treatment involving radiotherapy has been proven to be effective in improving local tumor control in the setting of neoadjuvant, adjuvant, and definitive treatment (9,28,29).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of¹⁸F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study

Lee

Chung

et al. 2016

J Nucl Med

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This study aimed to assess the prognostic value of 18 F-FDG uptake in hepatocellular carcinoma (HCC) patients who had transarterial chemoembolization (TACE) or concurrent intraarterial chemotherapy with external-beam radiotherapy (CCRT) and to compare the prognosis between patients treated with TACE and those with CCRT according to 18 F-FDG uptake. Methods: Two hundred fourteen intermediateto-advanced-stage HCC patients without extrahepatic metastasis who underwent staging 18 F-FDG PET/CT before TACE (153 patients) or CCRT (61 patients) were recruited from 7 hospitals. Progressionfree survival (PFS) and overall survival (OS) were compared using an optimal cutoff value for tumor-to-normal liver uptake ratio (TLR). Further, PFS and OS were compared according to treatment modalities (TACE vs. CCRT) using the same TLR cutoff value. Results: On multivariate analysis, age and TLR were independent prognostic factors for PFS (P , 0.050). For OS, Child-Pugh classification and TLR were independent prognostic factors (P , 0.050). When the TLR was greater than 2.0, patients treated with CCRT showed significantly better PFS and OS than those treated with TACE after adjusting for tumor size and number (P 5 0.014, for all). In contrast, there was no significant difference in PFS and OS between patients treated with TACE or CCRT when the TLR was 2.0 or less. Conclusion: 18 F-FDG uptake was an independent prognostic factor for PFS and OS in HCC patients treated with TACE or CCRT. Especially, in HCCs with high 18 F-FDG uptake, patients treated with CCRT showed better survival than those treated with TACE.

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“…Complete pathological response after chemoembolization has a more favorable outcome compared with partial response. [25,26] Allard et al. reported that a complete or nearly complete pathologic response improves long-term survival after liver resection.…”

Section: Discussionmentioning

confidence: 99%

Preoperative transarterial chemoembolization for resectable hepatocellular carcinoma in Asia area: a meta-analysis of random controlled trials

Chen

et al. 2016

Scandinavian Journal of Gastroenterology

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Objective: We aimed to systematically evaluate the influence of preoperative transarterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) on long-term prognosis and perioperative safety. Materials and methods: Databases including PubMed, Embase, Cochrane, Wanfang, CNKI, VIP data were searched, combined with Manual Retrieval and Cited Reference Search to collect the published randomized controlled trial (RCT) about the influence of pre-TACE for curative resection of HCC. The searching cutoff date was 2016/02/25, all the data obtained were statistically analyzed using RevMan5.2 software recommended by Cochrane Collaboration. Results: A total of 5 RCT including 430 (pre-TACE group: 212, surgery alone group: 218) patients were included. The results of meta-analysis showed that: there was no difference between the 2 groups on overall survival (OS) rate [HR 1.25, 95%CI (0.92–1.68)], disease free survival (DFS) rate [HR 0.95 (0.76–1.19)], perioperative mortality rate [OR 0.70 (0.22–2.30)], or blood loss [SMD 0.07 (−0.14–0.29)], whereas the subgroup analysis revealed that pre-TACE would result in longer operation time [SMD 0.31 (0.06–0.57)], higher postoperative morbidity rate [OR 1.90 (1.02–3.53)] and combined resection rate of perihepatic organs [OR 5.46 (2.73–11.78)] in subgroup with mean tumor diameter >5cm. Conclusions: According to our study, pre-TACE treatment cannot improve the long-term prognosis of resectable HCC. With the growth of the tumor diameter, especially when it is over 5cm, it might add difficulties to surgery and affect the perioperative safety.

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Complete response at first chemoembolization is still the most robust predictor for favorable outcome in hepatocellular carcinoma

Cited by 169 publications

References 35 publications

Survival of patients with intermediate stage hepatocellular carcinoma treated with superselective transarterial chemoembolization using doxorubicin-loaded DC Bead under cone-beam computed tomography control

Survival of patients with intermediate stage hepatocellular carcinoma treated with superselective transarterial chemoembolization using doxorubicin-loaded DC Bead under cone-beam computed tomography control

Prognostic Significance of¹⁸F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study

Preoperative transarterial chemoembolization for resectable hepatocellular carcinoma in Asia area: a meta-analysis of random controlled trials

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Complete response at first chemoembolization is still the most robust predictor for favorable outcome in hepatocellular carcinoma

Cited by 169 publications

References 35 publications

Survival of patients with intermediate stage hepatocellular carcinoma treated with superselective transarterial chemoembolization using doxorubicin-loaded DC Bead under cone-beam computed tomography control

Survival of patients with intermediate stage hepatocellular carcinoma treated with superselective transarterial chemoembolization using doxorubicin-loaded DC Bead under cone-beam computed tomography control

Prognostic Significance of18F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study

Preoperative transarterial chemoembolization for resectable hepatocellular carcinoma in Asia area: a meta-analysis of random controlled trials

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Prognostic Significance of¹⁸F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study