Abstract
PurposeTo report technical success, safety profile and oncological results of balloon-occluded transcatheter arterial chemoembolization using a balloon micro-catheter and epirubicin-loaded polyethylene-glycol (PEG) microsphere (100 ± 25 µm and 200 ± 50 µm) in patients with hepatocellular carcinoma (HCC).Materials and MethodsThis is a single-centre, single-arm, retrospective study with 6-month follow-up. Twenty-two patients (Child–Pugh A 68% [15/22], B in 32% [7/22]; age 67.05 ± 14 years) with 29 HCC were treated in 24 procedures. Technical success is defined: ability to place the balloon micro-catheter within the required vascular segment, balloon-occluded arterial stump pressure drops and assessment of microsphere deposition. Laboratory assessment pre/post-procedural and complications were analysed, respectively, according to Common Terminology Criteria for Adverse Events (CTCAEv5) and CIRSE system. Postembolization syndrome (PES) was defined as fever and/or nausea and/or pain onset. Oncological results were evaluated using m-RECIST criteria with CT/MRI imaging at 1 and 3–6 months. In partial responder patients, pre/post-procedural tumour volume was compared.ResultsPre-planned feeder was reached in all cases. Pressure drop average was 51.1 ± 21.6 mmHg. Exclusive target embolization was achieved in 14/24 procedures (58.3%). Laboratory test modifications were all grade 1. 4/24 adverse events occurred (17%): pseudo-aneurysm of the feeder (grade 3), liver abscess (grade 2) and 2 asymptomatic segmentary biliary tree dilatations (grade 2). PES occurred in 8/24 (33%). The complete response at 1 and 3–6 months was 44.8% (13/29) and 52.9% (9/17), respectively. The partial response at 1 and 3–6 months was 55% (16/29) and 4/17 (23.5%), respectively. Among partial responder patients, the average percentage of tumour volume reduction was 64.9 ± 27.3%.ConclusionEpirubicin-loaded PEG microsphere b-TACE is technically feasible, safe and effective procedure for HCC treatment.
Highlights
Transarterial therapies represent the standard of care for intermediate hepatocellular carcinoma (HCC) not amenable to curative treatments and an option in early stage if surgery/ablation was contraindicated [1]
The aim of this study is to describe our experience with Balloon-assisted Transcatheter arterial chemoembolization (TACE) (b-TACE) performed with polyethylene-glycol epirubicinloaded drug-eluting embolics in HCC patients and report about the safety and preliminary oncological results at 3and 6-month follow-ups
Twenty-four b-TACE procedures were performed in 22 patients with 29 HCC
Summary
Transarterial therapies represent the standard of care for intermediate hepatocellular carcinoma (HCC) not amenable to curative treatments and an option in early stage if surgery/ablation was contraindicated [1]. Several retrospective studies comparing oncological results on patients treated with b-TACE with lipiodol, with those of an historical matched cohort treated with c-TACE, demonstrated that b-TACE may obtain better tumour control over c-TACE in tumours up to 4 cm [4, 7, 8]. Notwithstanding these advantages, it is to note that lipiodol conventional TACE (c-TACE) has shown several limitations (procedure standardization, toxicity profile, pain), overcome by the introduction of drug-eluting microsphere transarterial chemoembolization (DEMTACE) [9,10,11]
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