Rita Golfieri1, Mario Bezzi2, Gontran Verset3, Fabio Fucilli4, Cristina Mosconi1, Alberta Cappelli1, Alexandro Paccapelo1, Pierleone Lucatelli2, Nicolas Magand5, Agnes Rode5, Thierry De Baere6. 1. Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. 2. Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Rome, Italy. 3. Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium. 4. Radiology Unit, "S. De Bellis" National Institute of Gastroenterology Research Hospital, Bari, Italy. 5. Diagnostic and Interventional radiology Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France. 6. Department of Interventional Radiology, Gustave Roussy Cancer Center, Villejuif, France.
Abstract
INTRODUCTION: The aim of this multicenter comparison of balloon-occluded transarterial chemoembolization (B-TACE) versus conventional TACE (cTACE) in treating hepatocellular carcinoma (HCC) was to assess in which size range the 2 techniques offered higher complete response (CR) and objective response (OR) rates in a single session, and to evaluate the possibility of using B-TACE to reduce the need for re-treatment. METHODS: 325 patients were retrospectively evaluated: 91 patients in the B-TACE group (22 with cTACE [B-cTACE] and 69 with drug-eluting microsphere TACE [B-DEM-TACE]) and 234 in the cTACE group. The results were compared according to tumor size: (A) <30 mm, (B) 30-50 mm, and (C) >50 mm; OR and CR rates after the first session and the number of TACE re-interventions within a 6-month period were also evaluated using propensity score matching (PSM). RESULTS: The best target ORs were very high (93.2%) and similar between the 2 treatments both before (94.4% for cTACE and 90.1% for B-TACE) and after PSM (94.5% for cTACE and 90.1%; p = 0.405), with slightly better results for the cTACE cohort probably due to better cTACE effectiveness in smaller lesions. In lesions <30 mm, cTACE obtained a slightly higher CR rate than B-TACE (61.9 vs. 56.3%, p = 0.680), whereas in intermediate-sized HCCs (30-50 mm), B-TACE showed a significant superiority in achieving a CR (72.3 vs. 54.1%, respectively; p = 0.047). In larger lesions (>50 mm), cTACE and B-TACE performed equally, with a poor CR rate (22.6 vs. 23.1%, respectively; p = 1.000). These results were additionally confirmed using PSM. The patients treated with B-TACE had a significantly lower re-treatment rate than the cTACE cohort (12.1 vs. 26.9%, respectively; p = 0.005). B-cTACE and B-DEM-TACE demonstrated similar ORs, with a slightly better CR rate for B-cTACE (68.2 vs. 56.5%, respectively; p = 0.456). CONCLUSION: In HCCs of 30-50 mm, B-TACE should be preferred to cTACE, whereas in smaller nodules (<30 mm), cTACE can suffice in achieving a good CR rate. The statistically significant lower re-treatment rate of the B-TACE cohort after a single procedure reduced the risk of complications due to multiple TACE, which could worsen the patient prognosis.
INTRODUCTION: The aim of this multicenter comparison of balloon-occluded transarterial chemoembolization (B-TACE) versus conventional TACE (cTACE) in treating hepatocellular carcinoma (HCC) was to assess in which size range the 2 techniques offered higher complete response (CR) and objective response (OR) rates in a single session, and to evaluate the possibility of using B-TACE to reduce the need for re-treatment. METHODS: 325 patients were retrospectively evaluated: 91 patients in the B-TACE group (22 with cTACE [B-cTACE] and 69 with drug-eluting microsphere TACE [B-DEM-TACE]) and 234 in the cTACE group. The results were compared according to tumor size: (A) <30 mm, (B) 30-50 mm, and (C) >50 mm; OR and CR rates after the first session and the number of TACE re-interventions within a 6-month period were also evaluated using propensity score matching (PSM). RESULTS: The best target ORs were very high (93.2%) and similar between the 2 treatments both before (94.4% for cTACE and 90.1% for B-TACE) and after PSM (94.5% for cTACE and 90.1%; p = 0.405), with slightly better results for the cTACE cohort probably due to better cTACE effectiveness in smaller lesions. In lesions <30 mm, cTACE obtained a slightly higher CR rate than B-TACE (61.9 vs. 56.3%, p = 0.680), whereas in intermediate-sized HCCs (30-50 mm), B-TACE showed a significant superiority in achieving a CR (72.3 vs. 54.1%, respectively; p = 0.047). In larger lesions (>50 mm), cTACE and B-TACE performed equally, with a poor CR rate (22.6 vs. 23.1%, respectively; p = 1.000). These results were additionally confirmed using PSM. The patients treated with B-TACE had a significantly lower re-treatment rate than the cTACE cohort (12.1 vs. 26.9%, respectively; p = 0.005). B-cTACE and B-DEM-TACE demonstrated similar ORs, with a slightly better CR rate for B-cTACE (68.2 vs. 56.5%, respectively; p = 0.456). CONCLUSION: In HCCs of 30-50 mm, B-TACE should be preferred to cTACE, whereas in smaller nodules (<30 mm), cTACE can suffice in achieving a good CR rate. The statistically significant lower re-treatment rate of the B-TACE cohort after a single procedure reduced the risk of complications due to multiple TACE, which could worsen the patient prognosis.
Authors: Jong Won Choi; Jun Yong Park; Sang Hoon Ahn; Ki Tae Yoon; Heung-Kyu Ko; Do Yun Lee; Jong Tae Lee; Kyung Sik Kim; Jin Sub Choi; Kwang-Hyub Han; Chae Yoon Chon; Do Young Kim Journal: Am J Clin Oncol Date: 2009-12 Impact factor: 2.339
Authors: Daryl T Goldman; Manu Singh; Rahul S Patel; F Scott Nowakowski; Vivian Bishay; Mona Ranade; Robert A Lookstein; Aaron M Fischman Journal: J Vasc Interv Radiol Date: 2019-03 Impact factor: 3.464
Authors: Beom Kyung Kim; Seung Up Kim; Kyung Ah Kim; Yong Eun Chung; Myeong-Jin Kim; Mi-Suk Park; Jun Yong Park; Do Young Kim; Sang Hoon Ahn; Man Deuk Kim; Sung Il Park; Jong Yoon Won; Do Yun Lee; Kwang-Hyub Han Journal: J Hepatol Date: 2015-01-29 Impact factor: 25.083
Authors: N Matsuo; H Uchida; K Nishimine; S Soda; M Oshima; H Nakano; N Nagano; Y Nishimura; T Yoshioka; Q Guo Journal: J Vasc Interv Radiol Date: 1993 Jul-Aug Impact factor: 3.464
Authors: O Matsui; M Kadoya; J Yoshikawa; T Gabata; K Arai; H Demachi; S Miyayama; T Takashima; M Unoura; K Kogayashi Journal: Radiology Date: 1993-07 Impact factor: 11.105