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

Abstract

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.

Computed tomographic perfusion imaging for the prediction of response and survival to transarterial chemoembolization of hepatocellular carcinoma

“…Due to heterogeneity of the patient population tumor response and survival rates are variable. 1 , 4 , 5 , 9 , 10 , 11 The overall response rate for TACE treatment is about 50%, with the lowest reported around 15% and the highest around 85.6% 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Reported 1-, 2- and 3-year survival rates range from 37% to 91.5%, 14% to 75% and 58.8% to 71.4%, respectively. 1 , 3 , 4 Current prognostic factors for determination of treatment response and survival in patients treated with TACE are mainly based on clinical assessment and are included in the BCLC classification.…”

“… 1 , 2 Lately a new embolization agent called drug-eluting bead (DEB) has been introduced and several clinical studies have confirmed the benefits of DEBTACE with respect to improved tumor response, reduced adverse effects and improved survival. 2 , 3 , 4 , 5 , 6 , 7 , 8 …”

“…Due to heterogeneity of the BCLC B stage patient population survival rates are variable and scattered across the literature. 1 , 3 , 4 , 5 , 6 , 10 , 11 , 12 Therefore, not all patients with intermediate stage HCC will derive similar benefit from TACE. Some may benefit from other treatment options which are currently approved or being explored.…”

Update on Transarterial Chemoembolization with Drug-Eluting Microspheres for Hepatocellular Carcinoma

“…Drug-eluting microsphere transcatheter arterial chemoembolization is a safe procedure for patients with HCC, with reports showing low rates of serious complications (1.6–7.2%) (2051). These complications included hepatic insufficiency or infarction, liver abscess, tumor rupture, bile duct injury, cholecystitis, upper gastrointestinal bleeding, pleural effusion, pulmonary embolism, splenic infarction, and spinal embolization.…”

Efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE) combined with radiofrequency ablation versus DEB-TACE alone in Chinese hepatocellular carcinoma patients

“…The CR and ORR of DEB-TACE in HCC patients realize a range of approximately 32% to 42.4% and 51% to 94.5% in several previous studies, displaying good treatment responses. [15–17] While for RFA, previous studies indicate responses rates of RFA in HCC patients with a CR range roughly at 20% to 90%. [18–20] Prior studies show that combining TACE with RFA realizes relatively encouraging treatment responses.…”