4:21 PM Abstract No. 140 Imaging and pathological outcomes of drug-eluting bead-transarterial chemoembolization for treatment of hepatocellular carcinoma using 70- to 150-μm versus 100- to 300-μm beads

Abstract

To compare pathological tumor necrosis and radiological response to drug-eluting bead-transarterial chemoembolization (DEB-TACE) using 70-150 μm versus 100-300 μm beads in patients with hepatocellular carcinoma (HCC) undergoing liver transplantation. Between September 2010 and April 2017, 31 patients with HCC received DEB-TACE (as the sole bridging modality to liver transplantation) with either 70-150 μm (n = 13) or 100-to 300-μm (n = 18) beads, loaded with a mean doxorubicin dose of ∼70 mg. Patients in the 70- to 150-μm and 100-to 300-μm cohorts shared similar baseline characteristics with respect to age, gender, primary tumor diameter, Child-Pugh classification, and MELD score. Patients who had received DEB-TACE with bead size combinations were not included in the study. Index tumor response to treatment was evaluated by both the mRECIST criteria (using the last available follow-up imaging) and pathological determination of the percentage of actual tumor necrosis (using liver explants). TACE-to-imaging and TACE-to-pathology intervals were nearly equivalent among the study groups. Percentage of pathological tumor necrosis, presence of complete (100%) pathological or radiological response to treatment, and treatment failure (less than 30% pathological necrosis) were compared between the groups. Student’s t-test and Fisher’s exact test were used for analysis of continuous and categorical data, respectively. Radiological complete response, average pathological tumor necrosis, and complete pathological tumor necrosis did not prove to be statistically different among the 70-150 μm and 100-300 μm cohorts; however, the incidence of treatment failure (necrosis <30%) was significantly higher in the 100-300 μm cohort (Table). DEB-TACE with larger beads (100-300 μm) may demonstrate higher rates of treatment failure. Larger multi-center studies are warranted to further elucidate the role of bead size on DEB-TACE treatment efficacy in HCC patients.Tabled 170-150 μm beads (n = 13)100-300 μm beads (n = 18)P ValueRadiologic complete response9 (69%)8 (44%)0.27Average pathological tumor necrosis81.54% ± 5.87%64.17% ± 9.97%0.18Complete pathological tumor necrosis6 (46%)6 (33%)0.71Treatment failure0 (0%)6 (33%)0.03 Open table in a new tab