Conventional transarterial chemoembolization versus drug-eluting bead transarterial chemoembolization for the treatment of hepatocellular carcinoma

Abstract

BackgroundTo compare the overall survival of patients with hepatocellular carcinoma (HCC) who were treated with lipiodol-based conventional transarterial chemoembolization (cTACE) with that of patients treated with drug-eluting bead transarterial chemoembolization (DEB-TACE).MethodsBy an electronic search of our radiology information system, we identified 674 patients that received TACE between November 2002 and July 2013. A total of 520 patients received cTACE, and 154 received DEB-TACE. In total, 424 patients were excluded for the following reasons: tumor type other than HCC (n = 91), liver transplantation after TACE (n = 119), lack of histological grading (n = 58), incomplete laboratory values (n = 15), other reasons (e.g., previous systemic chemotherapy) (n = 114), or were lost to follow-up (n = 27). Therefore, 250 patients were finally included for comparative analysis (n = 174 cTACE; n = 76 DEB-TACE).ResultsThere were no significant differences between the two groups regarding sex, overall status (Barcelona Clinic Liver Cancer classification), liver function (Child-Pugh), portal invasion, tumor load, or tumor grading (all p > 0.05). The mean number of treatment sessions was 4 ± 3.1 in the cTACE group versus 2.9 ± 1.8 in the DEB-TACE group (p = 0.01). Median survival was 409 days (95 % CI: 321–488 days) in the cTACE group, compared with 369 days (95 % CI: 310–589 days) in the DEB-TACE group (p = 0.76). In the subgroup of Child A patients, the survival was 602 days (484–792 days) for cTACE versus 627 days (364–788 days) for DEB-TACE (p = 0.39). In Child B/C patients, the survival was considerably lower: 223 days (165–315 days) for cTACE versus 226 days (114–335 days) for DEB-TACE (p = 0.53).ConclusionThe present study showed no significant difference in overall survival between cTACE and DEB-TACE in patients with HCC. However, the significantly lower number of treatments needed in the DEB-TACE group makes it a more appealing treatment option than cTACE for appropriately selected patients with unresectable HCC.

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

“…DEB-TACE has been shown to be safe and effective in palliative HCC treatment in several clinical and preclinical studies (27,(36)(37)(38)(39)(40)(41), as well as in a randomized clinical trial (RCT) comparing DEB-TACE with cTACE (23,26), but the evidence to support its use as a neoadjuvant treatment before OLT is scarce (25,(42)(43)(44)(45)(46). To our knowledge, this is the first clinical study that compares OS and DFS of patients that did and did not receive DEB-TACE before OLT and one of the largest series assessing neoadjuvant DEB-TACE clinical results in the literature so far.…”

Evaluation of drug-eluting beads versus conventional transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma: A systematic review and meta-analysis

“…Two articles [18,38], which were written by the same author, failed to provide data related to patient affiliation with the same group, and therefore, were also considered as one study [18]. Finally, 16 studies [20,22,29,39], 3 prospective cohorts [21,40,41], 9 retrospective cohorts [16][17][18][19]23,30,[42][43][44]). The quality scores of the four RCTs assessed by JADAD scale are 4 [20,22,39] and 5 [29].…”

Multidisciplinary Taiwan Consensus Recommendations for the Use of DEBDOX-TACE in Hepatocellular Carcinoma Treatment

“…If the larger feeding hepatic arteries become occluded and inaccessible, future TACE procedures may be rendered much more difficult. Therefore, we recommend using the smaller 100- to 300-μm beads, which allows good tumor penetration while preserving normal hepatic feeding arteries [38]. …”