Chemoembolization In Patients Research Articles

Is Hepatic Resection Better than Transarterial Chemoembolization for Patients with Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis?

Is Hepatic Resection Better than Transarterial Chemoembolization for Patients with Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis?

Three-Dimensional Quantitative Color-Coding Analysis of Hepatic Arterial Flow Change during Chemoembolization of Hepatocellular Carcinoma

PurposeTo evaluate feasibility of using three-dimensional (3D) quantitative color-coding analysis (QCA) to quantify substasis endpoints after transcatheter arterial chemoembolization of hepatocellular carcinoma (HCC). Materials and MethodsThis single-institution prospective study included 20 patients with HCC who had undergone segmental or subsegmental transcatheter arterial chemoembolization between December 2015 and March 2017. The chemoembolization endpoint was a sluggish anterograde tumor-feeding arterial flow without residual tumor stains. Contrast medium bolus arrival time (BAT) was used as an indicator of arterial flow. BAT of the proper hepatic artery was obtained as a reference point. BATs of the proximal right lobar artery, proximal left lobar artery, and segmental artery that received embolization were analyzed before and after chemoembolization. Wilcoxon signed rank test was used to evaluate the difference between BATs before and after chemoembolization. ResultsBATs before and after chemoembolization of the segmental artery that received embolization were 0.47 seconds (interquartile range [IQR], 0.31–0.70 s) and 1.04 seconds (IQR, 0.78–2.01 s; P < .001), respectively. BATs before and after chemoembolization of the proximal left lobar hepatic artery (0.35 s [IQR, 0.11–0.55] and 0.13 s [IQR, 0.05–0.32], P = .025) and right lobar hepatic artery (0.23 s [IQR, 0.13–0.65] and 0.22 s [IQR, 0.08–0.39], P = .027) exhibited no significant change. Conclusions3D QCA is a feasible method for quantifying sluggish segmental arterial flow after transcatheter arterial chemoembolization in patients with HCC.

Five-year outcome of conventional and drug-eluting transcatheter arterial chemoembolization in patients with hepatocellular carcinoma

BackgroundCurrently, no standard of care or therapies have been established for patients with advanced HCC. We evaluated the efficacy and safety of conventional transarterial chemoembolization using gelatin sponges or microspheres plus lipiodol-doxorubicin (cTACE) and TACE with doxorubicin-loaded drug eluting beads (DEB-TACE).MethodsThis retrospective study included 273 patients who received cTACE (n = 201) or DEB-TACE. Tumor response, survival, and adverse events were evaluated over a 5-year follow-up period.ResultsDuring 5-year follow-up, a greater percentage of patients treated with cTACE died than those treated with DEB-TACE (76.1% vs. 66.7%) (P = 0.045). At the last evaluation, all surviving patients had disease progression and no differences were seen between treatment groups. However, the time to disease progression differed between groups; median time to disease progression was 11.0 months for cTACE and 16.0 months for DEB-TACE (P = 0.019). The median survival time was 37 months in both treatment groups. No significant differences were observed between cTACE and DEB-TACE therapies in subgroups of patients with BCLC stage A or stage B + C either in survival time or time to disease progression (P values > 0.05). No significant differences were observed in survival status or disease progression between cTACE and DEB-TACE in patient subgroups with either tumor number > 5 or with the sum of the diameter of largest five HCC tumors being > 7 cm.ConclusionsDEB-TACE demonstrates greater long-term benefits than cTACE in treating treatment-naïve patients with HCC. Results of this long-term study support the use of DEB-TACE in treating HCC.

Hepatic Progression-free and Overall Survival After Regional Therapy to the Liver for Metastatic Melanoma.

Regional therapy for metastatic melanoma to the liver represents an alternative to systemic therapy. Hepatic progression-free survival (HPFS), progression-free survival (PFS), and overall survival (OS) were evaluated. A retrospective review of patients with liver metastases from cutaneous or uveal melanoma treated with yttrium-90 (Y90), chemoembolization (CE), or percutaneous hepatic perfusion (PHP) was conducted. Thirty patients (6 Y90, 10 PHP, 12 CE, 1 PHP then Y90, 1 CE then PHP) were included. Multivariate analysis showed improved HPFS for PHP versus Y90 (P=0.004), PHP versus CE (P=0.02) but not for CE versus Y90. PFS was also significantly different: Y90 (54 d), CE (52 d), PHP (245 d), P=0.03. PHP treatment and lower tumor burden were significant predictors of prolonged PFS on multivariate analysis. Median OS from time of treatment was longest, but not significant, for PHP at 608 days versus Y90 (295 d) and CE (265 d), P=0.24. Only PHP treatment versus Y90 and lower tumor burden had improved OS on multivariate analysis (P=0.03, 0.03, respectively). HPFS and PFS were significantly prolonged in patients treated with PHP versus CE or Y90. Median OS in PHP patients was over double that seen in Y90 or CE patients but was significant only between PHP and Y90.

Multicenter Phase II Clinical Trial of Sorafenib Combined with Transarterial Chemoembolization for Advanced Stage Hepatocellular Carcinomas (Barcelona Clinic Liver Cancer Stage C): STAB Study

PurposeTo evaluate safety and efficacy of combining sorafenib with transarterial chemoembolization in patients with advanced stage hepatocellular carcinomas (HCCs). Materials and MethodsSystemic chemotherapy–naïve patients with a Child-Pugh class A liver profile and advanced stage HCCs were enrolled. Sorafenib therapy (daily dose 800 mg) was initiated within 4 weeks after initial conventional transarterial chemoembolization with an allowance of subsequent on-demand conventional chemoembolization. The primary endpoint was rate of protocol treatment completion, which was defined as sorafenib administration for at least 2 months. Secondary endpoints included objective response rate, disease control rate, overall survival, progression-free survival, and incidence of adverse events. Thirty-one patients (24 men, 7 women; median age, 75 years; vascular invasion, n = 19; extrahepatic metastases, n = 18; both, n = 6) who met the inclusion criteria were enrolled. ResultsProtocol treatment was completed in 28 patients (90.3%, 28/31) with median protocol treatment duration of 7.0 months (range, 0.5–30 months) and median of 2 (range, 1–4) transarterial chemoembolization sessions. Objective response rate was 77.4% with median overall and progression-free survival of 17.3 months (95% confidence interval, 11.9–22.6 months) and 5.4 months (95% confidence interval, 4.6–6.2 months), respectively. The most common grade 3 or 4 adverse events were self-limiting elevation of aspartate aminotransferase (54.8%, 17/31) and alanine aminotransferase (45.2%, 14/31). ConclusionsThis combination therapy is feasible and promising in patients with advanced stage HCCs.

Cell-free DNA and chemoembolization in patients with liver metastases from colorectal cancer.

The European Clinical Trials database (EudraCT no. 2012-000987-11) at 05-14-2012.

Validation of the SNACOR clinical scoring system after transarterial chemoembolisation in patients with hepatocellular carcinoma

BackgroundTransarterial chemoembolisation is the standard of care for intermediate stage (BCLC B) hepatocellular carcinoma, but it is challenging to decide when to repeat or stop treatment. Here we performed the first external validation of the SNACOR (tumour Size and Number, baseline Alpha-fetoprotein, Child-Pugh and Objective radiological Response) risk prediction model.MethodsA total of 1030 patients with hepatocellular carcinoma underwent transarterial chemoembolisation at our tertiary referral centre from January 2000 to December 2016. We determined the following variables that were needed to calculate the SNACOR at baseline: tumour size and number, alpha-fetoprotein level, Child-Pugh class, and objective radiological response after the first transarterial chemoembolisation. Overall survival, time-dependent area under receiver-operating characteristic curves, Harrell’s C-index, and the integrated Brier score were calculated to assess predictive ability. Finally, multivariate analysis was performed to identify independent predictors of survival.ResultsThe study included 268 patients. Low, intermediate, and high SNACOR scores predicted a median survival of 31.5, 19.9, and 9.2 months, respectively. The areas under the receiver-operating characteristic curve for overall survival were 0.641, 0.633, and 0.609 at 1, 3, and 6 years, respectively. Harrell’s C-index was 0.59, and the integrated Brier Score was 0.175. Independent predictors of survival included tumour size (P < 0.001), baseline alpha-fetoprotein level (P < 0.001) and Child-Pugh class (P < 0.004). Objective radiological response (P = 0.821) and tumour number (P = 0.127) were not additional independent predictors of survival.ConclusionsThe SNACOR risk prediction model can be used to identify patients with a dismal prognosis after the first transarterial chemoembolisation who are unlikely to benefit from further transarterial chemoembolisation. However, Harrell’s C-index showed only moderate performance. Accordingly, this risk prediction model can only serve as one of several components used to make the decision about whether to repeat treatment.

Phase I Trial of Dose-escalated Whole Liver Irradiation With Hepatic Arterial Fluorodeoxyuridine/Leucovorin and Streptozotocin Followed by Fluorodeoxyuridine/Leucovorin and Chemoembolization for Patients With Neuroendocrine Hepatic Metastases

We have previously shown that refractory neuroendocrine tumors can respond to moderate doses of chemoradiotherapy. We completed a dose-escalation phase I/II trial combining hepatic arterial (HA) chemotherapy, chemoembolization, and dose-escalated whole liver radiotherapy to determine the maximum safe dose of radiation that could be delivered and to make a preliminary assessment of response. From 2002 to 2009, 19 patients with symptomatic neuroendocrine liver metastases who failed somatostatin analog therapy were enrolled. HA fluorodeoxyuridine, leucovorin, and streptozotocin were delivered, as concurrent whole liver radiotherapy was dose escalated from 24 to 32 Gy in 2 Gy fractions, with a target rate of dose-limiting grade ≥3 radiation-induced liver disease of 10%. Eight weeks later, for patients without grade ≥3 liver or grade ≥4 any toxicity, a 72-hour infusion of HA fluorodeoxyuridine and leucovorin was given, followed by transarterial chemoembolization. Eleven patients completed the entire protocol and received 24 to 32 Gy. No patients developed radiation-induced liver disease; 7 had grade 3 to 4 transiently increased liver function tests, and 4 had other grade 4 toxicities. Three patients (14%) had partial response, 16 (84%) stable disease. Median freedom from local progression and overall survival were 35.3 and 54.6 months, respectively. Thirty-two in 2 Gy daily fractions can be delivered safely when combined with HA chemotherapy and subsequent transarterial chemoembolization. However, although objective responses were observed, this combination was not significantly better than our prior approaches. Further treatment intensification strategies, including individualized dose escalation for radiation-tolerant livers, and improved radiosensitization should be investigated, along with improved systemic therapy.

THU-184 - A novel model for the outcome prediction of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma with or without impaired hepatic function

THU-184 - A novel model for the outcome prediction of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma with or without impaired hepatic function

ARTERIAL CHEMOEMBOLIZATION IN PATIENTS WITH LOCALLY ADVANCED PANCREATIC CANCER

OBJECTIVe. The article is devoted to the study of the safety and the effectiveness of the arterial chemoembolization in patients with locally advanced pancreatic cancer. MATERIAL AND METHODS. Between 2000 and 2015, 52 patients with unresectable locally advanced cancer of the pancreatic head without remote meastases T3-4n0-1M0 were treated with chemoembolization of the gastroduodenal artery. 109 cycles of chemoembolization (from 1 to 7, average 2) were performed. RESULTS. Manifestations of postembolization syndrome were stopped within 24 hours with conservative therapy. chemotherapeutic toxicity of I degree was observed in 44 (85 %) patients, gastrointestinal toxicity of II–III degree – in 8 (15 %). clinical effect such as increased body mass and reduction of pain was achieved after performing two cycles in the majority of patients: 90 and 71 %, respectively. The average life expectancy of the entire group was 9.9, median of 6.7 months. however, these figures were higher in14 patients received three or more cycles: 14.4 and 9.6 months. oily chemoembolization of the arteries of the pancreas is a relatively safe method of treatment in patients with inoperable cancer of the pancreas head. Performing of the multiple cycles increases patient survival.

Analysis of risk factors for acute kidney injury following hepatic arterial chemoembolization inpatients with hepatocellular carcinoma of Child class A

Objective To explore the incidence and risk factors of acute kidney injury (AKI) following hepatic arterial chemoembolization inpatients with hepatocellular carcinoma (HCC) , Child class A. Methods Retrospective analysis was performed on patients with HCC, Child Class A who were admitted from January 2008 to October 2016.The inclusion criteria: (1) patients were diagnosed with pathologically confirmed hepatocellular carcinoma based on the standards of primary liver cancer diagnosis and treatment (2011 edition);(2) patients have complete laboratory parameters and imaging data within the 7 days before the TACE treatment;(3) the Child-pugh score was 5 to 6;(4) patients have no acute or chronic renalfailure before the treatment of TACE.The morbidity of AKI after TACE was investigated.Twenty-six factors such as age,sexy,contrast dose,hemoglobin were included as independent variable, so as to investigate the risk factors for postoperative AKI. Results A total of 818 patients were included in the study, including 38 experiencing postoperative AKI(4.64%). Multivariate logistic regression analysis identified elevated preoperative uric acid as the independent risk factor for postoperative AKI(OR=1.005, 95% CI 1.000 to 1.009,P=0.037), and elevated preoperative hemoglobin as the protective factor for postoperative AKI(OR=0.974, 95% CI 0.952 to 0.997,P=0.028). Conclusions AKI is not uncommon following hepatic arterial chemoembolization inpatients with HCC, Child Class A, and is correlated with elevated uric acid and anemia. Preoperative risk assessment and anemia correction might be effective for reducing the incidence of AKI following hepatic arterial chemoembolization. Key words: Carcinoma, hepatocellular; Chemoembolization, therapeutic; Acute kidney injury

Fluorouracil, leucovorin and irinotecan combined with intra-arterial hepatic infusion of drug-eluting beads preloaded with irinotecan in unresectable colorectal liver metastases: side effects and results of a concomitant treatment schedule. Clinical investigation.

Safety evaluation of concomitant systemic chemotherapy and liver chemoembolization in patients with colorectal cancer. Seven patients with metastases confined to the liver were included and stratified into two groups, depending of dosage of systemic chemotherapy. The first group received systemic chemotherapy (FOLFIRI) with 20% dose reduction, and the second group received the full dose of the same chemotherapy. In both groups, chemoembolization of liver metastases with drug-eluting bead irinotecan (DEBIRI) was performed following the application of systemic chemotherapy. The toxicity profiles of the two groups were compared. Of the 7 patients included, 4 received the reduced systemic chemotherapy dose and 3 received the full chemotherapy dose. DEBIRI was performed in all 7 patients. The main toxicities observed in the reduced chemotherapy dose group were leukopenia (25%), anorexia (75%), diarrhea (25%), vomiting (25%), right upper abdominal quadrant pain (100%) and elevated serum amylase level (25%). Main toxicities observed in the full chemotherapy dose group were anorexia (66.6%), vomiting (33.3%), right upper abdominal quadrant pain (100%), and elevated serum amylase level (66.6%). There were no significant differences between the two groups ( P = 0.78541). Patients with isolated liver metastases from a colorectal primary can safely be treated with DEBIRI chemoembolization and a full dose of systemic chemotherapy (FOLFIRI).

3:36 PM Abstract No. 275 ■ FEATURED ABSTRACT EpCAM-positive circulating tumor cells independently predict poor outcomes of transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma

To assess the role of epithelial cell adhesion molecule (EpCAM)-positive circulating tumor cell (CTC) count in predicting outcomes of transcatheter arterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC). EpCAM-positive CTC counts were prospectively determined in peripheral blood of 97 patients with unresectable HCC treated with TACE, using CellSearch system. The impact of each cutoff point (each CTC value) on overall survival (OS) was evaluated by the univariate Cox regression analysis. Based on the hazard ratio (HR), the patients were divided into 3 groups: low risk (CTC = 0 and 1), moderate risk (CTC = 2-5) and high risk (CTC≥6) groups. Cox proportional hazards model was used to assess the correlation of CTC counts with outcomes. Eighty-nine patients were enrolled in this study according to patient-selection criteria. The low risk group was used as the control group for univariate Cox analysis. Mortality risk in the high risk and moderate risk groups was 4.164 (95% Confidence Interval [CI], 2.042-8.492, P = 0.000) and 1.695 (95%CI, 0.883-3.253, P = 0.113) times higher, respectively, than that in the low-risk group. On multivariate Cox regression analysis, CTC count was found to be an independent predictor of OS (P = 0.049) and progression-free survival (PFS) (P = 0.007) in patients treated with TACE. After adjustment for confounding factors, the mortality risk in the high risk and moderate risk groups was 2.819 times (95%CI, 1.218-6.526, P = 0.016) and 1.301 times (95%CI, 0.630-2.685, P = 0.477) higher than that in the low risk group. EpCAM-positive CTC count can independently predict poor outcomes of TACE in patients with unresectable HCC.

3:09 PM Abstract No. 272 Imaging predictors for tumor response to drug-eluting bead transarterial chemoembolization in patients with advanced hepatocellular carcinoma

3:09 PM Abstract No. 272 Imaging predictors for tumor response to drug-eluting bead transarterial chemoembolization in patients with advanced hepatocellular carcinoma

Abstract No. 538 Radioembolization results in improved efficacy and overall survival compared to chemoembolization in patients with hepatocellular carcinoma and elevated alpha-fetoprotein

Abstract No. 538 Radioembolization results in improved efficacy and overall survival compared to chemoembolization in patients with hepatocellular carcinoma and elevated alpha-fetoprotein

3:18 PM Abstract No. 401 Efficacy and safety of CalliSpheres® drug-eluting beads transarterial chemoembolization in patients with secondary liver cancer: a preliminary result from CTILC study

3:18 PM Abstract No. 401 Efficacy and safety of CalliSpheres® drug-eluting beads transarterial chemoembolization in patients with secondary liver cancer: a preliminary result from CTILC study

Plasma MicroRNA-21, 26a, and 29a-3p as Predictive Markers for Treatment Response Following Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma.

BackgroundWe investigated an association between the levels of plasma microRNA (miRNA)-21, -26a, and -29a-3p and treatment outcomes following transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC).MethodsA total of 198 patients with TACE-treated HCC were followed up for TACE refractoriness and liver transplantation (LT)-free survival. Pretreatment plasma miRNA-21, -26a, and -29a-3p levels were measured using quantitative real-time polymerase chain reaction.ResultsDuring the mean follow-up of 22.3 (range, 0.7–79) months, 118 (59.6%) patients exhibited TACE refractoriness. Multivariate analyses showed that expression of a specific combination of miRNAs (miRNA-21 ≥ 2.5, miRNA-26a ≥ 1.5, and miRNA-29a-3p < 0.4) was associated with early TACE refractoriness (within 1 year; hazard ratio [HR], 2.32; 95% confidence interval [CI], 1.08–4.99; P = 0.031) together with tumor size (HR, 4.62; 95% CI, 1.50–14.21; P = 0.008), and macrovascular invasion (HR, 3.80; 95% CI, 1.19–12.20; P = 0.025). However, miRNA-21, -26a, and -29a-3p levels were not significantly associated with overall TACE refractoriness or LT-free survival. Additionally, large tumor size and macrovascular invasion were common predictive factor of overall TACE refractoriness and survival.ConclusionCombination of plasma miRNA-21, -26a, and -29a-3p expression could predict early TACE refractoriness in patients with TACE-treated HCC.

Radiofrequency Ablation Combined With Transarterial Chemoembolization for Specially Located Small Hepatocellular Carcinoma.

Objective:To investigate the safety and efficacy of radiofrequency ablation combined with transarterial chemoembolization in patients with specially located small hepatocellular carcinoma.Materials and Methods:Between March 2014 and March 2017, a total of 26 patients with 26 lesions (10 perivascular, 6 subdiaphragmatic, 5 subcapsular, 5 perivascular, and subdiaphragmatic location; mean diameter 2.12 (0.62) cm), who received radiofrequency ablation–transarterial chemoembolization treatment, were retrospectively analyzed. Local tumor response was assessed by computed tomography/magnetic resonance imaging 1 month after the procedure. Tumor-free survival was also assessed according to the modified Response Evaluation Criteria in Solid Tumors. Complications were evaluated according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events (version 4.0).Results:Complete response was achieved in all patients 1 month after the procedure. During a median follow-up duration of 16.76 months (95% confidence interval: 7.78-25.73 months), local tumor recurrence occurred in 2 patients and new intrahepatic lesions developed in 7 patients. The 1-, 2-, and 3-year cumulative local tumor progression rates were 3.84%, 7.69%, and 7.69%, respectively. The median tumor-free survival duration was 21.96 months (95% confidence interval: 17.58-26.34 months). The 1-, 2-, and 3-year tumor-free survival rates were 67.4%, 46.1%, and 39.3%, respectively.Conclusion:The radiofrequency ablation–transarterial chemoembolization combination therapy appears to be safe and effective and might be a treatment option for specially located small hepatocellular carcinoma lesions that have a risk of incomplete ablation or major complications.

Transarterial chemoembolization in patients with hepatocellular carcinoma: study of different outcomes and their predictive factors

Transarterial chemoembolization in patients with hepatocellular carcinoma: study of different outcomes and their predictive factors

Transarterial chemoembolization in patients with hepatocellular carcinoma: Study of different outcomes and their predictive factors

Transarterial chemoembolization in patients with hepatocellular carcinoma: Study of different outcomes and their predictive factors