Initial Transarterial Chemoembolization (TACE) Using HepaSpheres 20-40 µm and Subsequent Lipiodol TACE in Patients with Hepatocellular Carcinoma > 5 cm.

Jin Hyung Kim,Jong Woo Kim,Dong Il Gwon,Su Min Cho,Hee Ho Chu

doi:10.3390/life11040358

Abstract

Purpose: To investigate clinical outcomes of drug-eluting bead transarterial chemoembolization (DEB-TACE) using HepaSpheres 20–40 µm in diameter and subsequent cisplatin-based lipiodol TACE (Cis-TACE) in patients with hepatocellular carcinoma (HCC) > 5 cm. Materials and Methods: This study included 39 consecutive patients (34 men, 5 women; mean age, 63.5 years; range, 39–80 years) who underwent DEB-TACE using HepaSpheres 20–40 µm as first-line treatment for HCC > 5 cm (mean diameter, 8.2 cm; range, 5.1–13 cm) between September 2018 and August 2019. Patients with new tumors, residual tumors, or tumor growth after initial DEB-TACE underwent subsequent Cis-TACE. Results: All 39 patients underwent initial DEB-TACE successfully, with 35 (89.7%) and three (7.7%) patients experiencing minor and major complications, respectively. After initial DEB-TACE, one patient (2.6%) achieved complete response (CR), 35 (89.7%) achieved partial response (PR), and three (7.7%) experienced progressive disease (PD). During a median follow-up period of 14.4 months (range, 0.6–23 months), 23 patients underwent Cis-TACE, with 11, three, and nine achieving CR, PR, and PD, respectively. The median overall survival time was 20.9 months (95% confidence interval (CI), 18.6–23.2 months), the median time to progression was 8.8 months (95% CI, 6.5–11.1 months), and the median time to local tumor recurrence was 16 months (95% CI, 7.4–24.6 months). Conclusions: DEB-TACE using HepaSpheres 20–40 µm in diameter can be a safe and effective initial treatment method in patients with HCC > 5 cm. Subsequent Cis-TACE constitutes a good adjuvant method to enhance tumor response after initial DEB-TACE.

Highlights

Conventional transarterial chemoembolization (C-TACE) using emulsions of lipiodol and chemotherapeutic agent(s) has been found to improve survival rate in patients with unresectable hepatocellular carcinoma (HCC) [1,2], this method has important drawbacks associated with techniques and scheduling, which have not yet been standardized [3]
Patients with HCC were considered ineligible for treatment with DEB-TACE for HCC if they had any contraindication to an arterial procedure, such as impaired clotting, bacterial infection, or renal failure
The mean number of vials injected into each patient was 2.2 and the mean dose of doxorubicin was 110 mg

Summary

Introduction

Conventional transarterial chemoembolization (C-TACE) using emulsions of lipiodol and chemotherapeutic agent(s) has been found to improve survival rate in patients with unresectable hepatocellular carcinoma (HCC) [1,2], this method has important drawbacks associated with techniques and scheduling, which have not yet been standardized [3]. Drug-eluting bead TACE (DEB-TACE) has several advantages over C-TACE, such as the delivery of higher concentrations of chemotherapeutic agents directly to tumors, lower rates of systemic complications, greater efficacy in advanced stage or large tumors, and better standardization of the procedure itself [4,5,6,7,8,9,10]. Selecting the optimal therapeutic approach for patients with large, inoperable HCCs is important.

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