Endovascular treatment of hepatocellular carcinoma with drug eluting microparticles (DC-Beads): CT evaluation of response to the treatment

Abstract

Background and Study Aims:Our aim was to assess the efficacy and tolerability of drug-eluting beads-transarterial chemoembolization (DEB-TACE) in the treatment of hepatocellular carcinoma (HCC), evaluating the response to the treatment after 1, 6, 12, and 24 months with multidetector computed tomography (MDCT) comparing European Association for the study of the Liver (EASL) and modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria.Materials and Methods:We enrolled 154 patients with uni- or multifocal HCC who underwent a DEB-TACE. A total of 278 HCC nodules were treated. CT follow-up was performed at 1, 6, 12, and 24 months after the procedure according to the EASL and RECIST criteria evaluating overall target and target nodule response. We also analyzed the shrinking of nodules in relation to response to treatment.Results:A total of 278 nodules of HCC underwent TACE by using DC-Beads: At 24, months complete response was similar for EASL and RECIST criteria (112 vs. 121 nodules) with optimal accordance between methods and readers with k = 0.9. Partial Response resulted significantly different among the two methods within the first month, otherwise was similar after 24-month follow-up. Similar results in both methods were found for nodules classified as Stable Disease (P > 0.05). Progressive Disease results were similar in both the groups according to both the classification criteria without any significant difference (P > 0.05).Conclusion:Our study confirmed that EASL and mRECIST criteria are both effective methods for patient follow-up, however with some technical differences.

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

“…In another prospective, randomized study, DEBDOX TACE resulted in a better objective response than bland embolization with non-loaded bead (73.1% versus 55.9%, respectively) 10 . Similarly, Boatta and colleagues showed a 72% objective response rate in 154 patients treated with DEBDOX TACE 24 . In a study by Suk et al ., where CBCT after DEBDOX TACE was used to predict short-term tumor response according to mRECIST, objective response was achieved in 85.6% of patients (complete response 63.8%, partial response 21.8%), and objective response rates at one month after CBCT-guided TACE was also reported in a study by Loffroy et al .…”

“…With improved treatment efficacy and tolerance, DEBDOX TACE represents a major advancement in treatment of intermediate stage HCC 2 , 6 , 9 , 10 , 23 . In a recent prospective, randomized phase II study comparing cTACE with DEBDOX TACE, the DEBDOX TACE group showed a trend for a higher objective response rate than the cTACE group (51.6% versus 43.5%, respectively), together with better tolerability 8 , 24 . In another prospective, randomized study, DEBDOX TACE resulted in a better objective response than bland embolization with non-loaded bead (73.1% versus 55.9%, respectively) 10 .…”

Prognostic Relevance of Objective Response According to EASL Criteria and mRECIST Criteria in Hepatocellular Carcinoma Patients Treated with Loco-Regional Therapies: A Literature-Based Meta-Analysis

“…One was focused on the prognostic role of number of target lesions more than on that of response criteria [ 13 ]. Another study reported response and survival data at specific time point, so that it was not possible to extract the overall data [ 14 ]. In five works authors chose RECIST 1.0, RECIST 1.1 or volumetric RECIST version as comparator response criteria [ 15 – 19 ].…”

Evaluation of the viability of hepatocellular carcinoma in the caudate lobe using contrast-enhanced endoscopic ultrasonography after transarterial chemoembolization

“…The treatment effects of DEB-TACE are usually evaluated with contrast-enhanced examinations,[23] and CE-US has also been reported to be useful for assessing the outcomes of DEB-TACE. [4] Another advantage of CE-US is that it can be performed repeatedly in patients with renal dysfunction.…”