Retrospective European Multicentric Evaluation of Selective Transarterial Chemoembolisation with and without Balloon-Occlusion in Patients with Hepatocellular Carcinoma: A Propensity Score Matched Analysis

Rita Golfieri,Pierleone Lucatelli,Thierry De Baere,Alexandro Paccapelo,Cristina Mosconi,Nicolas Magand,Alberta Cappelli,Agnes Rode,Mario Bezzi,Fabio Fucilli,Gontran Verset

doi:10.1007/s00270-021-02805-5

Abstract

PurposeThe aim of this retrospective multicentric study was to compare the tumour response rates of Balloon-occluded Transarterial Chemoembolisation (B-TACE) to non-B-TACE using propensity score matching (PSM) in patients with hepatocellular carcinoma and to investigate the clinical benefit, such as lower rates of TACE re-intervention achieved using B-TACE.Material and MethodsThe B-TACE procedures (n = 96 patients) were compared with a control group of non-B-TACE treatments (n = 434 pts), performed with conventional (cTACE) or drug-eluting microspheres TACE (DEM-TACE). Data were collected from six European centres from 2015 to 2019.Objective responses (OR) and complete response (CR) rates after the first session and the number of TACE re-interventions were evaluated using PSM (91 patients per arm).ResultsThe best target OR after PSM were similar for both B-TACE and non-B-TACE (90.1% and 86.8%, p = 0.644); however, CR at 1–6 months was significantly higher for B-TACE (59.3% vs. 41.8%, p = 0.026). Patients treated with B-TACE had a significantly lower retreatment rate during the first 6 months (9.9%% vs. 22.0%, p = 0.041). Post-embolisation syndrome (PES) rates were 8.8% in non-B-TACE and 41.8% in B-TACE (p < 0.001), with no significant differences between groups regarding major adverse events.ConclusionB-TACE is safe and effective, achieving higher CR rates than non-B-TACE. Patients undergoing B-TACE had a significantly lower retreatment rate within the first 6 months but higher PES rates.Level of Evidence IIILevel 3, retrospective study.

Highlights

Transarterial chemoembolisation (TACE) can be performed using two different TACE techniques: conventional TACE, which uses LipiodolÒ, and TACE with drug-eluting microspheres loaded with cytotoxic agents (DEM-TACE), without significant differences in either tumour response or overall survival [1,2,3]
The best target responses were similar between the two treatments, with Objective responses (OR) of 88.9 and 90.1, and complete response (CR) of 50.2% and 59.3% for TACE and Balloon-occluded Transarterial Chemoembolisation (B-TACE), respectively (Table 2)
After propensity score matching (PSM), a slightly better OR was observed for B-TACE (90.1% vs. 86.8% p = 0.644), albeit not significant; the CR was significantly higher for B-TACE (59.3% vs. 0.41.8%, p = 0.026)

Summary

Introduction

Transarterial chemoembolisation (TACE) can be performed using two different TACE techniques: conventional TACE (cTACE), which uses LipiodolÒ, and TACE with drug-eluting microspheres loaded with cytotoxic agents (DEM-TACE), without significant differences in either tumour response or overall survival [1,2,3]. Liver arterial hemodynamics [16] involved two types of the terminal hepatic artery; the first ends within the portal tract through the peribiliary vascular plexus (PBP) This is the drainage area of intrahepatic metastasis and microsatellitosis (and of the residual /relapse of the disease) which is often not reached by the chemotherapy mixture if injected in free flow during cTACE/DEMTACE [17, 18]. Some previous reports have compared the results of safety and efficacy on patients treated with B-TACE versus non-B-TACE; all were single centre cohort studies involving a relatively small number of subjects and the majority of them used miriplatin Their results, demonstrated that the therapeutic effect of B-TACE was better than that of non-B-TACE [26,27,28,29]. The present multicentric study was a retrospective comparative evaluation of B-TACE versus non-B-TACE treatments, carried out using propensity score matching (PSM), with the aim of first evaluating the efficacy of B-TACE in terms of objective (OR) and complete response (CR) rates according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria after one session and, second, investigating whether a clinical benefit, such as lower rates of TACE re-intervention (performed according to an on-demand treatment strategy), could be achieved using B-TACE

Materials and Methods

Results

Discussion

Conclusion