Abstract
OBJECTIVE:Transarterial chemoembolization is the treatment of choice for intermediate-stage hepatocellular carcinoma. However, there are no clear data supporting transarterial chemoembolization vs. transarterial embolization or regarding the best chemotherapeutic agent, which may suggest a preponderant role of ischemia over chemotherapeutic action. This study sought to evaluate the radiological response and outcome of transarterial chemoembolization modified by n-butyl cyanoacrylate addition compared to conventional transarterial chemoembolization in hepatocellular carcinoma patients.MATERIALS AND METHODS:A retrospective review identified forty-seven patients who underwent modified chemoembolization and thirty-three who underwent conventional chemoembolization between June 2006 and December 2011. The radiological response was reassessed using the modified Response Evaluation Criteria in Solid Tumors. The sustained complete response, time to progression and overall survival rates were also analyzed.RESULTS:Complete response rates were significantly higher in patients who had undergone modified chemoembolization compared to those who had undergone conventional treatment (61.7% and 24.3%, respectively; p<0.001). The rate of sustained complete response was significantly higher in the modified chemoembolization group compared to the conventional chemoembolization group (median of 236 and 37 days, respectively; p<0.001). Time to progression was significantly higher in the modified chemoembolization group compared to the conventional chemoembolization group (median of 424 and 201 days, respectively; p=0.042). Overall survival rates revealed no difference between patients who received modified chemoembolization and conventional chemoembolization (median of 483 and 399 days, respectively; p=0.316).CONCLUSION:Transarterial chemoembolization modified by n-butyl cyanoacrylate addition was superior to conventional transarterial chemoembolization in terms of the radiological response in the first imaging control. Although the sustained complete response and time to progression rates were higher for the modified chemoembolization group, no differences in overall survival rates were observed.
Highlights
The exclusion criteria were as follows: diagnosis of any tumor other than HCC; failure to proceed in conventional TACE (cTACE) or N-butyl cyanoacrylate (NBCA)-Transarterial chemoembolization (TACE) due to highflow arteriovenous fistula; unavailability of multidetector computed tomography (MDCT) or magnetic resonance imaging (MRI) for review and reassessment before the procedure; and refusal of patients or family members to have their data included in this study
There were no significant differences in the baseline data (p40.05) except for hepatitis C virus infection, which was more frequent in the NBCA-TACE group (p=0.005) and MDCT, which was more frequent for the cTACE group than for the NBCA-TACE group in the first imaging control
For the cTACE group, the response analysis of the target lesion according to the modified response evaluation criteria in solid tumors (mRECIST) criteria revealed 24.3% of patients with complete response (CR), 54.6% with partial response (PR), 12.1% with stable disease (SD), 6.1% with progressive disease (PD) and 3.0% who were not amenable for analysis
Summary
Transarterial chemoembolization (TACE) is the treatment of choice for intermediate-stage hepatocellular carcinoma. No potential conflict of interest was reported. There are no clear data supporting TACE over transarterial embolization (TAE) and there is no significant difference in survival rates between patients who receive TAE or TACE [3,4]. No chemotherapeutic agent has been shown to be better than others in TACE procedures [3]. The ischemic effect of TACE might be dominant over the chemotherapeutic effect
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