Elisabeth G Klompenhouwer1,2, Raphaëla C Dresen1, Chris Verslype3, Annouschka Laenen4, Gert De Hertogh5, Christophe M Deroose6, Lawrence Bonne1, Vincent Vandevaveye1, Geert Maleux7. 1. Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. 2. Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. 3. Department of Digestive Oncology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. 4. Department of Biostatistics and Statistical Bioinformatics, KU Leuven Universiteit Hasselt, Kapucijnenvoer 35, 3000, Louvain, Belgium. 5. Department of Pathology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. 6. Nuclear Medicine, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. 7. Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. geert.maleux@uzleuven.be.
Abstract
INTRODUCTION: Transarterial chemoembolisation (TACE) is the most widely used locoregional treatment for patients with an unresectable hepatocellular carcinoma (HCC). Transarterial radioembolisation (TARE) with yttrium-90 containing microspheres is an emerging interventional treatment that could be complementary or an alternative to TACE. AIM: To evaluate the safety and efficacy of TARE in patients with HCC who are refractory to TACE with drug-eluting beads (DEB-TACE). METHODS: We identified all patients who received TARE for HCC following one or more sessions of DEB-TACE in the period 2007-2016. Grade ≥3 adverse events were graded according to Common Terminology Criteria for Adverse events. Response on MRI was determined on MRI by modified RECIST. Overall survival was estimated using the Kaplan-Meier method and was determined from the first TACE and from the TARE procedure. RESULTS: A total of 30 patients were included. Patients had a mean of 1.7 TACE procedures (range 1-4) prior to TARE. Grade 3 adverse events following TARE included: fatigue (20%), bilirubin increase (10%), cholecystitis (3.3%) and a gastric ulcer (3.3%). Response on MRI was achieved in 36.7%. Three patients (10%) were downstaged within the Milan criteria and received liver transplantation. The median overall survival after first TACE was 32.3 months (17.2-42.1 95% CI). The median overall survival after TARE was 14.8 months (8.33-26.5 95% CI). CONCLUSION: TARE is safe and can be effective in patients with an intermediate or advanced stage HCC who are refractory to TACE. This treatment strategy has the potential to downstage to liver transplantation.
INTRODUCTION: Transarterial chemoembolisation (TACE) is the most widely used locoregional treatment for patients with an unresectable hepatocellular carcinoma (HCC). Transarterial radioembolisation (TARE) with yttrium-90 containing microspheres is an emerging interventional treatment that could be complementary or an alternative to TACE. AIM: To evaluate the safety and efficacy of TARE in patients with HCC who are refractory to TACE with drug-eluting beads (DEB-TACE). METHODS: We identified all patients who received TARE for HCC following one or more sessions of DEB-TACE in the period 2007-2016. Grade ≥3 adverse events were graded according to Common Terminology Criteria for Adverse events. Response on MRI was determined on MRI by modified RECIST. Overall survival was estimated using the Kaplan-Meier method and was determined from the first TACE and from the TARE procedure. RESULTS: A total of 30 patients were included. Patients had a mean of 1.7 TACE procedures (range 1-4) prior to TARE. Grade 3 adverse events following TARE included: fatigue (20%), bilirubin increase (10%), cholecystitis (3.3%) and a gastric ulcer (3.3%). Response on MRI was achieved in 36.7%. Three patients (10%) were downstaged within the Milan criteria and received liver transplantation. The median overall survival after first TACE was 32.3 months (17.2-42.1 95% CI). The median overall survival after TARE was 14.8 months (8.33-26.5 95% CI). CONCLUSION:TARE is safe and can be effective in patients with an intermediate or advanced stage HCC who are refractory to TACE. This treatment strategy has the potential to downstage to liver transplantation.
Authors: Max Masthoff; Philipp Schindler; Fabian Harders; Walter Heindel; Christian Wilms; Hartmut H Schmidt; Andreas Pascher; Lars Stegger; Kambiz Rahbar; Moritz Wildgruber; Michael Köhler Journal: Ann Transl Med Date: 2020-09
Authors: Michael Köhler; Moritz Wildgruber; Max Masthoff; Philipp Schindler; Fabian Harders; Walter Heindel; Christian Wilms; Hartmut H Schmidt; Andreas Pascher; Lars Stegger; Kambiz Rahbar Journal: J Cancer Res Clin Oncol Date: 2020-11-06 Impact factor: 4.553