Abstract
BackgroundTo compare the efficacy and safety between conventional transarterial chemoembolization (cTACE) and drug-eluting beads TACE (DEB-TACE) in patients with infiltrative hepatocellular carcinoma (iHCC).MethodsA total of 89 iHCC patients who were treated with either cTACE (n = 33) or DEB-TACE (n = 56) between April 2013 and September 2017 were included in this retrospective study. Patients with the situations that might have a poor outcome were defined as advanced disease including Child-Pugh class B, bilobar lesions, tumor size greater than 10 cm, ECOG 1–2, tumor burden of 50–70%, and the presence of ascites, arterioportal shunt (APS), and portal venous tumor thrombus (PVTT). The tumor response was measured 1-month and 3-month after the procedure. Progression-free survival (PFS) was calculated. Toxicity was graded by Common Terminology Criteria for Adverse Events v5.0 (CTCAE v5.0). The differences in tumor response, PFS, and toxicity were compared between the DEB-TACE group and cTACE group.ResultsAt 1-month and 3-month after the procedure, the objective response rate (ORR) in the overall study population was similar in DEB-TACE group and cTACE group. The disease control rate (DCR), at 1-month after the procedure, was significantly higher in the patients treated with DEB-TACE relative to those treated with cTACE (P = 0.034), while after 3 months, the difference did not differ between two groups. DEB-TACE showed a higher DCR than cTACE in patients with tumor size greater than 10 cm (P = 0.036) or associated with APS (P = 0.030) at 1-month after the procedure, while after 3 months, the difference was only noted in patients with APS (P = 0.036). The median PFS in DEB-TACE group was 96 days, while in cTACE group was 94 days, and there was no difference in PFS between two groups (P = 0.831). In the side effect analysis, abdominal pain (P = 0.034) and fever (P = 0.009) were more frequently present in the cTACE group than DEB-TACE group, but there was no difference in high grade liver toxicity between the two groups.ConclusionsCompared to cTACE, DEB-TACE offers slightly better DCR and tolerability for iHCC patients, particularly in patients associated with APS and large tumor size. However, DEB-TACE does not provide higher PFS than cTACE.
Highlights
To compare the efficacy and safety between conventional transarterial chemoembolization and drug-eluting beads TACE (DEB-TACE) in patients with infiltrative hepatocellular carcinoma
The exclusion criteria were as follows (Fig. 2): (a) patients in whom we were unable to assess the tumor response according to the modified Response Evaluation Criteria in Solid Tumors for example the lesion was less than 1 cm, the lesion was unsuitable for repeat measurement, the lesion did not show intratumoral arterial enhancement on contrastenhanced computed tomography (CT) or MRI (n = 12); (b) patients who lost follow-up (n = 7); (c) patients received radiofrequency or microwave ablation prior to TACE (n = 9)
The diagnosis of infiltrative hepatocellular carcinoma (iHCC) was made based on pathology or American Association for the Study of Liver (AASLD) practice guidelines (n = 68)
Summary
To compare the efficacy and safety between conventional transarterial chemoembolization (cTACE) and drug-eluting beads TACE (DEB-TACE) in patients with infiltrative hepatocellular carcinoma (iHCC). Due to the high propensity of portal vein involvement, patients with iHCC are not candidates for curative treatments, such as transplantation, hepatectomy, and local ablation [10, 11]. Palliative treatment, such as transarterial chemoembolization (TACE), is occasionally shown to be beneficial for such patients [8, 9, 12, 13]. The purpose of this study was to investigate and compare efficacy and safety between DEB-TACE and cTACE in patients with iHCC
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