Efficacy of Combined Therapy with Drug-Eluting Beads-Transcatheter Arterial Chemoembolization Followed by Conventional Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Multi-Center Study

Asahiro Morishita,Kei Takuma,Tomoko Tadokoro,Akio Moriya,Yoshihiro Nishiyama,Tsutomu Masaki,Koichi Takaguchi,Joji Tani,Koji Fujita,Takashi Himoto,Takanori Matsui,Tadayuki Takata,Takako Nomura,Tomonori Senoo,Kyoko Oura,Takayuki Sanomura,Tingting Shi,Hiroki Yamana,Tetsu Tomonari,Masaru Nakahara

doi:10.3390/cancers13184605

Abstract

Simple SummaryDrug-eluting beads-transcatheter chemoembolization (DEB-TACE) has recently been performed. However, local recurrence of HCC at the tumor margins is often observed. Conventional transcatheter chemoembolization (cTACE) comprises accumulating lipiodol-containing anticancer drugs into the drainage area, which is the first invasive site of hepatocellular carcinoma (HCC). We evaluate the therapeutic effect of DEB-TACE followed by cTACE in patients with intermediate stage HCC. HCC patients were divided into two groups: one group received DEB-TACE followed by cTACE (cTACE group) and the other group received only DEB-TACE (non-cTACE group). The complete response (CR) rate was significantly higher in the cTACE group than in the non-TACE group. The only factor that increased the complete response rate in the cTACE group was the number of tumors. The overall survival (OS) rate of CR patients was higher than that of non-CR patients in the cTACE group. cTACE group adverse events included severe thrombocytopenia but only in one patient. The combined therapy with DEB-TACE followed by cTACE may be useful for HCC patients.EB-TACE has recently been performed because of its lower hepatotoxicity compared to cTACE in less advanced HCC. However, local recurrence at the tumor margins is often observed after DEB-TACE. cTACE involves filling the intratumoral sinusoids with lipiodol-containing anticancer drugs and accumulating in the drainage area, which is the first site of HCC recurrence. The aim of this study is to evaluate the therapeutic effect of DEB-TACE followed by cTACE in HCC patients. Between 2014 and 2020, 65 patients with Barcelona clinic liver cancer (BCLC) stage B (intermediate stage) of HCC were enrolled and divided into two groups: one group received DEB-TACE followed by cTACE (cTACE group) and the other group received only DEB-TACE (non-cTACE group). Sixty-five patients were medically followed. The median observation time was 14 ± 13.1 months after the first DEB-TACE and outcomes were analyzed for multiple factors. Results: The complete response rate was significantly higher in the cTACE group than in the non-TACE group. The analysis showed that the only factor that increased the CR rate in the cTACE group was the total tumor number (less than four). The OS rate of CR patients was higher than that of non-CR patients in the cTACE group. Adverse events in the cTACE group included severe thrombocytopenia but only in one of twenty-seven patients. Conclusions: The combined therapy with DEB-TACE followed by cTACE may be a new effective therapeutic strategy for the intermediate stage of HCC patients.

Highlights

HCC is the most common cancer [1,2] and the fourth-leading cause of death worldwide [3,4,5,6]
We addressed that issue by performing an additional cTACE procedure by passing lipiodol through the vasculature to be accumulated in the tumor’s drainage area (Figure 2f), which in turn might lead to an accumulation of lipiodol in the non-tumorous hepatic parenchyma around the liver tumor [19,33,34,35,36]
DEB-TACE has recently been performed for intermediate stage HCC

Summary

Introduction

HCC is the most common cancer [1,2] and the fourth-leading cause of death worldwide [3,4,5,6]. While surgery is the most effective therapy for HCC [8], most patients are diagnosed at advanced stages precluding surgical therapy For these patients, the conventional therapies are cTACE [9], radiofrequency ablation [10], molecular-targeting drugs, or these in combination therapies [2,11]. After DEB-TACE, residual areas are often found at the tumor margins, at which increased local recurrence can cause serious damage to the patient In other words, this residual area, at which drug-eluting beads cannot reach, reduces the CR rate. The aim of our study was to evaluate the efficacy and safety of combination therapy with DEB-TACE followed by cTACE in a short term for the treatment of the intermediate stage of unresectable liver cancer

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Methods

Results

Conclusion