Conventional versus Drug-eluting Beads Trans-arterial Chemoembolization for Treatment of Hepatocellular Carcinoma at Very Early and Early Stages

Abstract

Background/Aims: To retrospectively compare conventional and drug-eluting beads transarterial chemoembolization (C-TACE and DEB-TACE) for treatment of hepatocellular carcinoma (HCC) at very early and early stages. Methods:We retrospectively compared patients treated with C-TACE (n=115) or DEB-TACE (n=103) from September 2009 to May 2016. All patients were in a very early (stage 0) or early stage (stage A) of the Barcelona Clinic Liver Cancer (BCLC) staging system, and all had Child-Pugh class A and ≤B7 liver status. Approval by the institutional review board was waived because the study was retrospective. The following parameters were evaluated: severe pain and bradycardia during TACE, post-embolization syndrome (PES), liver function change, complications, target tumor response, and conversion to another treatment modality. Numeric differences were assessed by the independent Student's t-test for continuous variables and by chi-square test for categorical variables.Results: Severe intractable pain and bradycardia during the TACE procedure were significantly more frequent in the C-TACE group than in the DEB-TACE group (P<0.001). The incidence and duration of PES were significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The increase in liver enzymes was significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The deterioration of the Child-Pugh class was significantly higher in the C-TACE group than in the DEB-TACE group (P=0.006). There was no significant difference in serious complications except localized bile duct dilatation between the groups. There was no significant difference between the groups in tumor response at both immediate and 1-year assessment. The conversion rate to other treatment modalities was significantly higher in the DEB-TACE group than in the C-TACE group (P<0.001).Conclusions: DEB-TACE is better than C-TACE in terms of procedural safety as initial treatment in a very early or early stage of HCC. (J Liver Cancer 2017;17:144-152)

Drug-Eluting Bead Transarterial Chemoembolization Versus Radiofrequency Ablation as an Initial Treatment of Single Small (≤ 3 cm) Hepatocellular Carcinoma

“…Other studies have reported that cTACE could provide similar OS and PFS rates compared to RFA in patients with single small (≤ 3 cm, ≤ 2 cm, and 2–3 cm) HCC. 9 10 11 Although the findings of these previous studies were similar to the OS findings in this study, the previous studies were limited to cTACE.…”

“…In this study, the long-term OS was not statistically significantly different between the RFA and DEB-TACE groups, which may be because additional treatments such as TACE were actively performed for recurrent HCC in both treatment groups. Although several previous studies have compared the long-term survival and treatment responses of cTACE and RFA as first-line treatments in patients with single HCC measuring ≤ 3 cm, 9 10 11 little is known about the survival benefit of DEB-TACE in patients with single small HCC as an initial treatment compared to RFA. Hsu et al 12 compared the OS among patients with HCC treated with cTACE or RFA as an initial treatment and reported that the RFA group had a significantly better long-term OS than the cTACE group before PS matching, but that there was no significant difference in long-term OS after PS matching.…”

“… 7 8 Many earlier studies and meta-analyses comparing DEB-TACE and cTACE reported that procedural safety was better in DEB-TACE than cTACE, with fewer side effects and a lower incidence of liver and systemic toxicity. 9 …”

Superselective ablative chemo-ethanol embolization for recurrent single hepatocellular carcinoma: a 6-month outcome analysis

“…Overall, adverse events after SACE were similar to previous studies 24,[33][34][35] , and no serious events (grade 3 or higher) were reported. Additionally, no biliary complications or abscesses were noted.…”

Transarterial chemoembolization using drug-eluting bead compared with radiofrequency ablation for treatment of single small hepatocellular carcinoma: a pilot non-randomized trial

“… 20 , 21 In previous retrospective comparative study of conventional vs. DEB-TACE for small HCC, DEB-TACE provided more procedural safety than conventional TACE and tumor responses between two groups were not significantly different. 22 However, as the authors revealed as a study limitation, the study focused on early-term data at 1 year.…”