Transcatheter chemoembolization in the treatment of HCC in patients not eligible for curative treatments: midterm results of doxorubicin-loaded DC bead

Malagari, Katerina; Alexopoulou, Efthimia; Chatzimichail, Katerina; Hall, Brenda; Koskinas, John; Ryan, Samantha; Gallardo, Eva; Kelekis, Alexis; Gouliamos, A.; Kelekis, Dimitrios

doi:10.1007/s00261-007-9334-x

Cited by 95 publications

(75 citation statements)

References 27 publications

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“…In this regard, our results also indicate that TACE was associated with satisfactory survival rates in patients not eligible for curative treatments, corroborating recently reported data. 19,[28][29][30][31] Although both lipiodol and bead techniques were performed, our results indicate that TACE may be of value in these cases. Indeed, improved survival using TACE has been attributed to better early and accurate staging and bead chemoembolisation.…”

Section: Discussionmentioning

confidence: 91%

Application of the Barcelona Clinic Liver Cancer therapeutic strategy and impact on survival

et al. 2015

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Background: The Barcelona Clinic Liver Cancer (BCLC) classification of hepatocellular carcinoma (HCC) has proved useful in the management of HCC patients. However, BCLC-recommended first-line treatment is not always applicable in clinical practice.Objective: We performed a multicentre retrospective analysis of reasons for deviation from first-line treatment in 2008-2012. Methods: One to three-year survival data were analysed using Kaplan-Meier method. Results: A total of 407 consecutive HCC patients (66.6 AE 3 years, 83% male) with cirrhosis were included. Tumours were detected during surveillance in 53% of patients, grouped as Child-Pugh A (67%), B (25%) and C (8%); and BCLC A (including stage 0, 44%), B (26%), C (15%) and D (15%). In 31% of patients, first-line treatment was not feasible (51% in early stages) due to: technical reasons (74%); patient non-conformity (20%); medical decision (3%); and disease progression (3%). One to three-year survival of patients not receiving the recommended first-line treatment was similar to that of patients treated according to BCLC recommendations (log-rank, p ¼ 0.229). Conclusion: In real-life practice one-third of HCC patients could not receive first-line BCLC treatment. In our cohort of patients, similar short and medium-term survival was observed. Long-term prospective studies are required to determine the best alternative treatment option when BCLC first-line treatment is not feasible.

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Section: Discussionmentioning

confidence: 91%

Application of the Barcelona Clinic Liver Cancer therapeutic strategy and impact on survival

et al. 2015

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“…[32],weagreethatourpatientpopulation(n=24)was rather small and the follow-up interval was limited to 30 months.Attheendpointofdataanalysis,only42%ofthepa-tientswerealive(n=10)and58%haddied(n=14).Survival rates, based on a Kaplan-Meier analysis, demonstrated survivalprobabilitiesof83%after12monthsand42%after24 monthsinourpatients.TheseresultscanbecomparedtosurvivaldatafromaGreekmulticenterstudyin62patientswith unresectable HCC conducted by Malagari et al [25], where the survival rate was 98% 9 months after TACE. A major drawbackofourclinicalstudyisthefactthatwedidnotcompare chemoembolization with DC beads to other treatment modalities in unresectable HCC, like embolization with cisplatin, systemic chemotherapy or interferon therapy, as describedinpublishedmeta-analyses [33][34][35].AlthoughourpatientsdidnotallreceivethesameamountofDCbeadsduring chemoembolizationandneitherdidtheyreachthesamefollow-up stage at the endpoint, they clearly showed benefits from the TACE therapy.…”

Section: Probability Of Survival (%)mentioning

confidence: 99%

“…TheintentionofaTACEtherapyisalocal,highlyselective supplyofthetumorwithchemotherapyinordertoavoidsys- [23,25].TheadvantageofDCbeadsisthepossibilityofsuperselectivetranscatheter application, which induces tumor necrosis with almostnointerferencewiththesystemiccirculation [26,27].…”

Section: Probability Of Survival (%)mentioning

confidence: 99%

Application of DC Beads in Hepatocellular Carcinoma: Clinical and Radiological Results of a Drug Delivery Device for Transcatheter Superselective Arterial Embolization

Sadick¹,

Haas

Loehr

et al. 2010

Onkologie

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Aim: Application of a drug delivery device for transarterial chem-oembolization (TACE) in patients with hepatocellular carcinoma (HCC). Clinical and radiological treatment assessment. Patients and Methods: 24 patients with liver cirrhosis and uni- or multifocal HCC underwent TACE with doxorubicin beads (DC Bead^TM). The underly-ing cause of liver cirrhosis was hepatitis (A: n = 7; B: n = 10) or alco-hol consumption (n = 7). Patients presented with Child Pugh stage A (n = 15) and B (n = 9). The mean intrahepatic tumor size, consid-ering the sum of diameters of all lesions treated, was 3.83 cm (±2.4). Liver function and hematological parameters were docu-mented before and after each TACE. Magnetic resonance imaging (MRI) was performed before and 4 weeks after TACE. The T1-w 3D volume-interpolated breathhold exam (VIBE) sequence was applied for evaluation of the therapy response. Results: 24 patients received a total number of 69 TACE treatments with DC beads (mean dose 160 mg). The elevation of liver function parameters after treat-ment did not affect the patients’ clinical condition. The T1-w VIBE sequence proved very valuable for assessment of the intrahepatic tumor spread. Post-contrast images enabled delineation of the viable HCC lesions, hence facilitating the selective transcatheter ap-proach. The tumor marker a-fetoprotein (AFP), available in 19/24 patients, dropped from 347.5 to 299.5 ng/ml, without being a relia-ble predictor of treatment response. A decrease of tumor size after TACE from 3.83 (±2.40) to 3.01 cm (±2.67; p < 0.0001) was evident on the T1w-VIBE sequences. The mean follow-up period was 30 months. At the time of data analysis, 10 (42%) out of 14 patients were alive. Conclusion: TACE with DC beads in HCC offers a safe and efficient treatment resulting in tumor response within a very short time.

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“…These findings are suggestive of partial response to treatment. [26,27] . The concept of drug-eluting beads is based on a slow release of the drug within the liver, resulting in a low systemic drug concentration and subsequently a reduced incidence of common chemotherapeutic side effects [28,29] ; on the other hand, the slow release will also result in a prolonged uptake of cytotoxic drugs within the tumor cells.…”

Section: Future Directions and Research Agendasmentioning

confidence: 99%

Transcatheter Chemoembolization of Unresectable Hepatocellular Carcinoma: Current Knowledge and Future Directions

Maleux¹,

Malenstein

Vandecaveye³

et al. 2009

Dig Dis

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Transarterial chemoembolization (TACE) is considered the gold standard for the treatment of unresectable hepatocellular carcinoma (HCC) in patients with a preserved liver function and in the absence of clear extrahepatic tumor spread. This review article deals with the radiological and clinical workup, the interventional technique of chemoembolization for HCC and gives an overview of the common as well as some rare and dramatic complications of TACE. Finally, some new trends and advances in clinical research with regard to the interventional management of HCC are discussed.

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Transcatheter chemoembolization in the treatment of HCC in patients not eligible for curative treatments: midterm results of doxorubicin-loaded DC bead

Abstract: Transcatheter arterial chemoembolization with DC Bead is an effective and safe procedure in the treatment of HCC patients not eligible for curative treatments with high rates of response and high rates of mid term survival.

Cited by 95 publications

References 27 publications

Application of the Barcelona Clinic Liver Cancer therapeutic strategy and impact on survival

Application of the Barcelona Clinic Liver Cancer therapeutic strategy and impact on survival

Application of DC Beads in Hepatocellular Carcinoma: Clinical and Radiological Results of a Drug Delivery Device for Transcatheter Superselective Arterial Embolization

Transcatheter Chemoembolization of Unresectable Hepatocellular Carcinoma: Current Knowledge and Future Directions

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