Liver and biliary damages following transarterial chemoembolization of hepatocellular carcinoma: comparison between drug-eluting beads and lipiodol emulsion

Monier, Arnaud; Guiu, Boris; Durán, Rafael; Aho, Serge; Bize, Pierre; Deltenre, Pierre; Dunet, Vincent; Denys, Alban

doi:10.1007/s00330-016-4488-y

Cited by 92 publications

(70 citation statements)

References 33 publications

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“…Thus, an auspicious impact on OS in treatment of NELM disease was also expected [14, 32–35]. Yet, initial outcome reports for DEB-TACE in patients with NELM were disappointing, and in some cases significant toxicities, such as a higher incidence of biliary injury, occurred which required a modification of protocol [36, 37]. As reported previously, the MOS for patients after receiving cTACE can range from 24 to 44 months [27, 38].…”

Section: Discussionmentioning

confidence: 99%

Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and yttrium-90 radioembolisation as treatment options using a propensity score analysis model

et al. 2017

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Objective To compare efficacy, survival outcome and prognostic factors of conventional transarterial chemoembolization (cTACE), drug-eluting beads TACE (DEB-TACE) and 90Yttrium-radioembolization (Y90) for the treatment of liver metastases from gastro-entero-pancreatic (GEP) neuroendocrine tumors (NELM). Methods This retrospective analysis included 192 patients (58.6years mean age, 56%men) with NELM treated with cTACE(N=122), DEB-TACE(N=26), or Y90(N=44) between 2000 and 2014. Radiologic response to therapy was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) and World Health Organization (WHO) using peri-procedural MR imaging. Survival analysis included Propensity score analysis (PSA), median overall survival (MOS), hepatic progression-free survival, Kaplan-Meier using log-rank test and the uni-and multivariate Cox proportional hazards model (MVA). Results MOS of the entire study population was 28.8months. As for cTACE, DEB-TACE and Y90, MOS was 33.8months, 21.7months and 23.6months, respectively. According to the MVA, cTACE demonstrated a significantly longer MOS as compared to DEB-TACE(p=.04) or Y90(p=.032). The five-year survival rate after initial cTACE, DEB-TACE and Y90 was 28.2%, 10.3% and 18.5%, respectively. Conclusions Upon PSA, our study suggests significant survival benefits for patients treated with cTACE as compared to DEB-TACE and Y90. This data supports the therapeutic decision for cTACE as the primary intra-arterial therapy option in patients with unresectable NELM until proven otherwise.

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Section: Discussionmentioning

confidence: 99%

Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and yttrium-90 radioembolisation as treatment options using a propensity score analysis model

et al. 2017

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“…It has been reported that DEB‐TACE is associated with significantly more biliary injuries than c‐TACE . However, to our knowledge, there have been no reports of hemobilia immediately after DEB‐TACE for HCC with intrahepatic bile duct invasion.…”

Section: Discussionmentioning

confidence: 84%

Hemobilia immediately after transcatheter arterial chemoembolization using drug‐eluting beads for hepatocellular carcinoma with intrahepatic bile duct invasion

Nishi

Saeki

Yamasaki

et al. 2017

Hepatology Research

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Transcatheter arterial chemoembolization (TACE) is used as a palliative treatment for unresectable hepatocellular carcinoma (HCC) worldwide. Recently, a novel drug delivery-embolic agent, the drug-eluting bead (DEB), was introduced for TACE. There are a few reports of tumor hemorrhage after TACE using DEB (DEB-TACE) for HCC. However, there have not been any reports of hemobilia immediately after DEB-TACE for HCC with intrahepatic bile duct invasion. Here, the first such case is reported. A 71-year-old woman was admitted to our hospital to undergo DEB-TACE for multiple HCCs with worsening left intrahepatic bile duct dilatation. She was diagnosed with HCC that extensively invaded the left hepatic duct. After DEB-TACE through the left hepatic artery, a hepatic arteriogram showed extra flow of the contrast agent to the left hepatic and common bile ducts. Therefore, transcatheter arterial embolization (TAE) of the responsible vessel was carried out using coils, and no extra flow of the contrast agent was identified. The patient was discharged 14 days after TAE without deterioration of liver function. Although hemobilia immediately after DEB-TACE is rare, there may be increased potential for hemobilia when DEB-TACE is carried out for HCC with extensive bile duct invasion. We suggest that DEB-TACE may be contraindicated for such cases.

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“…Among 16 articles that retrospectively analyzed DEB‐TACE versus cTACE, five described the superiority of DEB‐TACE, three showed an advantage of cTACE, and the remaining eight showed equivalent effect or adverse events. Individual evaluation of objective response rate, TTP, OS, and adverse events, did not show definite advantages of DEB‐TACE over cTACE in these retrospective studies.…”

Section: Transcatheter Arterial Therapymentioning

confidence: 99%

Recent advances in medical management of hepatocellular carcinoma

Ikeda

2018

Hepatology Research

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Transcatheter arterial therapies for hepatocellular carcinoma (HCC) have developed during the last decade. A fine powder formulation of cisplatin and the new platinum agent miriplatin became standard medicines in addition to anthracyclines in transcatheter arterial chemoembolization (TACE) in Japan. Recent prospective and retrospective studies supported the usefulness of platinum agents as a chemotherapeutic at the time of varied TACE therapy. Although balloon-occluded TACE is an effective therapy for localized HCC and drug-eluting microspheres seemed to show a higher response rate in certain HCCs, the definite advantages of those procedures still remain uncertain. Intermediate stage HCC, or Barcelona Clinic Liver Cancer stage B, is regarded as a heterogeneous category with a wide spectrum of tumors and patients, and several subclassifications of the stage have been proposed to show different prognoses; there are also different recommended therapies in each subgroup. Authors have subclassified patients based on combinations of tumor size, tumor number, and liver function, with or without performance status. Because of differences of available medical resources and techniques in treatment procedures between countries, the most ideal and useful subgrouping remains inconclusive at present. Recently, a few systemic chemotherapies proved to be effective for advanced stage HCC in phase III studies: lenvatinib as the first line of therapy, and regorafenib, cabozantinib, and ramucirumab as second-line therapy. Other molecular-targeted and immune-oncological medicines are expected to follow in the near future. Some studies have suggested an advantage of early introduction of moleculartargeted therapy for TACE-resistant HCC in the intermediate stage.

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Liver and biliary damages following transarterial chemoembolization of hepatocellular carcinoma: comparison between drug-eluting beads and lipiodol emulsion

Abstract: • DEB-TACE demonstrated more therapy-related hepatic locoregional complications compared to cTACE. • TACE-related hepatic locoregional toxicities occurred more frequently with high baseline PT value. • cTACE may be more appropriate in patients with high baseline PT value.

Cited by 92 publications

References 33 publications

Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and yttrium-90 radioembolisation as treatment options using a propensity score analysis model

Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and yttrium-90 radioembolisation as treatment options using a propensity score analysis model

Hemobilia immediately after transcatheter arterial chemoembolization using drug‐eluting beads for hepatocellular carcinoma with intrahepatic bile duct invasion

Recent advances in medical management of hepatocellular carcinoma

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