Lei Zhang1, Jun-Hui Sun2, Jian-Song Ji3, Bin-Yan Zhong1, Guan-Hui Zhou2, Jing-Jing Song3, Zhong-Heng Hou1, Peng Huang1, Shen Zhang1, Zhi Li1, Xiao-Li Zhu1, Cai-Fang Ni1. 1. Department of Interventional Radiology, The First Affiliated Hospital of Soochow, University, Suzhou, China. 2. Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. 3. Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China.
Abstract
Background: Drug-eluting beads transarterial chemoembolization (DEB-TACE) has emerged as an alternative to conventional transarterial chemoembolization (cTACE) for treatment of hepatocellular carcinoma (HCC), although selection between the approaches remains controversial. Objective: To compare patients with unresectable HCC treated with DEB-TACE and cTACE in terms of hepatobiliary changes on imaging and clinical complications. Methods: This retrospective study included 1002 patients (871 men, 131 women; mean age, 59±12 years) from three centers with treatment-naïve unresectable HCC who underwent 780 DEB-TACE using epirucibin (780 procedures in 394 patients) and 1187 cTACE using lipiodol mixed with doxorubicin and oxaliplatin (1187 procedures in 608 patients) between May 2016 and November 2018. A total of 83.4% of patients had hepatitis B related liver disease; 57.6% were Barcelona Clinic Liver Cancer (BCLC) stage A or B; 42.4% had ≥3 nodules. Mean tumor size was 6.3±4.2 cm. Hepatobiliary changes and tumor response were evaluated on CT or MRI 1 month after TACE. Clinical records were reviewed for adverse events. Results: Bile duct dilation and portal vein narrowing on imaging, as well as liver failure and grade 3 abdominal pain on clinical follow-up, all had higher frequency (p<.05) in the DEB-TACE (15.5%, 4.6%, 2.3%, and 6.1%, respectively) versus the cTACE (7.4%, 1.6%, 0.7%, and 2.1%, respectively) group. Higher frequency of bile duct dilation for DEB-TACE was observed in subgroup analyses of patients with BCLC stage A or B, with cirrhosis, without cirrhosis, and without main portal vein tumor thrombus (all p<.05). Total bilirubin at 1 month was 1.5±2.4 mg/dl (95% CI, 1.2-1.8) for DEB-TACE versus 1.3±2 mg/dl (95% CI, 1.1-1.5) for cTACE (p=.02). cTACE and DEB-TACE groups were not different for other manifestations of post-embolization syndrome or systemic toxicity (p>.05). Local tumor disease control rate (DCR) was not different between cTACE and DEBTACE (p>.05), although overall DCR was higher in cTACE than DEB-TACE (1 month: 87.5% vs 80.0%, p=.001; 3 months: 78.5% vs 72.1%, p=.02). Conclusion: Compared with cTACE, DEB-TACE was associated with more frequent hepatobiliary injuries and severe abdominal pain. Clinical impact: Greater caution and closer follow-up are warranted for patients who undergo DEB-TACE for unresectable HCC.
Background: Drug-eluting beads transarterial chemoembolization (DEB-TACE) has emerged as an alternative to conventional transarterial chemoembolization (cTACE) for treatment of hepatocellular carcinoma (HCC), although selection between the approaches remains controversial. Objective: To compare patients with unresectable HCC treated with DEB-TACE and cTACE in terms of hepatobiliary changes on imaging and clinical complications. Methods: This retrospective study included 1002 patients (871 men, 131 women; mean age, 59±12 years) from three centers with treatment-naïve unresectable HCC who underwent 780 DEB-TACE using epirucibin (780 procedures in 394 patients) and 1187 cTACE using lipiodol mixed with doxorubicin and oxaliplatin (1187 procedures in 608 patients) between May 2016 and November 2018. A total of 83.4% of patients had hepatitis B related liver disease; 57.6% were Barcelona Clinic Liver Cancer (BCLC) stage A or B; 42.4% had ≥3 nodules. Mean tumor size was 6.3±4.2 cm. Hepatobiliary changes and tumor response were evaluated on CT or MRI 1 month after TACE. Clinical records were reviewed for adverse events. Results: Bile duct dilation and portal vein narrowing on imaging, as well as liver failure and grade 3 abdominal pain on clinical follow-up, all had higher frequency (p<.05) in the DEB-TACE (15.5%, 4.6%, 2.3%, and 6.1%, respectively) versus the cTACE (7.4%, 1.6%, 0.7%, and 2.1%, respectively) group. Higher frequency of bile duct dilation for DEB-TACE was observed in subgroup analyses of patients with BCLC stage A or B, with cirrhosis, without cirrhosis, and without main portal vein tumor thrombus (all p<.05). Total bilirubin at 1 month was 1.5±2.4 mg/dl (95% CI, 1.2-1.8) for DEB-TACE versus 1.3±2 mg/dl (95% CI, 1.1-1.5) for cTACE (p=.02). cTACE and DEB-TACE groups were not different for other manifestations of post-embolization syndrome or systemic toxicity (p>.05). Local tumor disease control rate (DCR) was not different between cTACE and DEBTACE (p>.05), although overall DCR was higher in cTACE than DEB-TACE (1 month: 87.5% vs 80.0%, p=.001; 3 months: 78.5% vs 72.1%, p=.02). Conclusion: Compared with cTACE, DEB-TACE was associated with more frequent hepatobiliary injuries and severe abdominal pain. Clinical impact: Greater caution and closer follow-up are warranted for patients who undergo DEB-TACE for unresectable HCC.
Authors: Tushar Garg; Apurva Shrigiriwar; Peiman Habibollahi; Mircea Cristescu; Robert P Liddell; Julius Chapiro; Peter Inglis; Juan C Camacho; Nariman Nezami Journal: Cancers (Basel) Date: 2022-07-10 Impact factor: 6.575