Abstract
Locoregional therapies for hepatocellular carcinoma (HCC) include endovascular treatments such as chemoembolization (TACE) and bland embolization (TAE). TACE is the most adopted technique, despite a lack of definitive evidence of superiority over TAE, which is less costly and better tolerated due to the absence of chemotherapy. However, few studies have reported data on TAE monotherapy for unresectable HCC. We report our results in a cohort of 230 patients with unresectable HCC treated with TAE (TAE with 40-100micron microparticles, TAE with microparticles plus n-butyl-2-cyanoacrylate, TAE with Lipiodol) over the course of seven years. Thirty-seven patients (14%) were down-staged during observation and also received a percutaneous ablation. We observed 1-, 2-, 3-, 4- and 5-year rates of 84,8%, 58,7%, 38,3%, 28,3%, and 18,7%. Patients who also received percutaneous treatment performed best. Our results broaden the body of evidence for the use of TAE in advanced HCC.
Highlights
Transarterial chemoembolization (TACE) is probably the most studied locoregional therapy for unresectable hepatocellular carcinoma (HCC) and is included in treatment algorithms of the European Association for the Study of the Liver (EASL), the Barcelona Clinic Liver Cancer (BCLC) and the American Association for the Study of Liver Disease (AASLD) [1].The term TACE is strictly related to the use of chemotherapeutic drugs in the compound injected intra-arterially; the advantage provided by chemotherapy compared to bland transarterial embolization (TAE) is unproven, whereas more adverse events and higher costs are reported [2,3]
This is due to the intrinsic chemoresistance of HCC [4], and TACE has not shown higher survival rates compared to TAE, mainly when this latter is performed
In this manuscript we report our experience in performing TAE in patients with advanced HCC, aiming to compare our results to heterogeneous literature about TAE and to broaden the body of evidence in favor of performing TAE instead of TACE
Summary
The term TACE is strictly related to the use of chemotherapeutic drugs in the compound injected intra-arterially; the advantage provided by chemotherapy compared to bland transarterial embolization (TAE) is unproven, whereas more adverse events and higher costs are reported [2,3]. This is due to the intrinsic chemoresistance of HCC [4], and TACE has not shown higher survival rates compared to TAE, mainly when this latter is performed. In this manuscript we report our experience in performing TAE in patients with advanced HCC, aiming to compare our results to heterogeneous literature about TAE and to broaden the body of evidence in favor of performing TAE instead of TACE
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