Drug eluting beads versus conventional TACE for unresectable hepatocellular carcinoma: Survival benefits and safety

Abstract

4524 Background: Conventional transarterial chemoembolization (TACE) has long been used as palliative transcatheter therapy for patients with unresectable hepatocellular carcinoma (HCC). Drug eluting beads (DEB) are a newer drug delivery system that can be loaded with doxorubicin. Though therapy with DEB is feasible, the survival advantage of this therapy over conventional TACE has not been established. Methods: Consecutive patients who received transcatheter therapy with Doxorubicin DEB or conventional TACE as sole therapy over a period of 1998 to 2008 were studied. Patients who underwent resection, transplantation, radioembolization or combination therapies have been excluded from the study. Statistical analysis was performed using Kaplan Meier Estimator with a log rank test, Chi-square and independent T-tests. Results: A total of 73 patients were included in the study, 47(64.4%) received therapy with DEB (group A) and 26(35.6%) underwent conventional TACE (group B). The demographic, tumor burden and liver reserve characteristics of patients in the two groups were statistically similar. Median survival from diagnosis of HCC in group A and B were 610 days(352–866) and 284 days(4–563) (p=0.03). Median survivals from the time of first transcatheter therapy in group A and B were 403 days(373–679) and 114 days (183–460)(p=0.01). The survival rates in group A and B at 6 months, 1yr and 2 yrs were 71%, 66%, 40% and 58%, 46%, 19%. On analysis of patients in Child Pugh class A and B, median survivals in group A and B were 390 days(298–491) and 114 days(41–187)(p=0.004). No difference in survival was found in Child Pugh class C. 6.4%(3/47) of patients treated with DEB and 7.7%(2/26) of patients treated with conventional TACE developed liver failure in the post procedure period. All patients who developed liver failure belonged to Child Pugh class C. No other major complications were reported in either group. Conclusions: In patients with unresectable HCC, transcatheter therapy with Doxorubicin eluting beads offers a survival advantage over conventional TACE. The safety profile of the two treatment modalities appears similar. No significant financial relationships to disclose.