9:04 AM Abstract No. 136 - Transarterial embolisation of hepatocellular carcinoma with doxorubicin-eluting beads: the singapore experience

Abstract

Purpose To analyze the safety and efficacy of transarterial chemoembolisation (TACE) with doxorubicin loaded drug eluting beads (DEB) in the treatment of hepatocellular carcinoma (HCC) in a South East Asian population. Materials and Methods Between Feb 2008 to Nov 2011, 116 patients underwent 182 sessions of DEB-TACE. Excluding the patients with inadequate follow-up, 83 patients (60 males; 23 females; mean age 66.74 years) from the above cohort were included into the study. DEB-TACE was done with 100-300, 300-500 and/ 500-700 micron beads. Follow up CT or MRI were reviewed and treatment response classified as a complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) as per EASL (European Association for the Study of Liver) guidelines. Periprocedual clinical and laboratory data was also analyzed. The average pre-treatment tumor volume was 105 cc. The mean number of DEB-TACE sessions per patient was 1.7 (range; 1-5). The median duration of follow up was 6 months (range; 2-40). Results At one month, 68.7 % of patients showed an objective response (OR) with CR in 31.3%, PR in 37.3%, SD in19.2% and PD in 12% patients. Twelve and 25 patients were censored from the study at 3 and 6 months from the baseline, respectively. The CR, PR, SD and PD at 3 and 6 month follow- up were 43.7%, 33.8%, 12.6%, 9.8% and 53.4%, 31%, 3.4% and 12 % respectively. A sustained OR for at least 6 months was seen in 56.6% of patients. The mean baseline volume of CR tumors was lower compared to tumors showing other responses. PD was mostly due to appearance of new lesions while base line tumor volume showed measurable decrease in response to TACE. Tumors with marked arterial enhancement had statistically significant better objective response than those with only capillary phase blush as seen at angiography. The liver- function tests showed only transient post embolisation changes. The major complications were non-flow limiting arterial dissection in one (1.2%) and self limiting bile lakes in 3 (3.6%) with no procedure related mortality. Conclusion DEB-TACE is safe and effective in the treatment of HCC with good objective response.