Doxorubicin Drug-eluting Beads Transarterial Chemoembolization Research Articles

Hepatocellular carcinomas within the Milan criteria: predictors of histologic necrosis after drug-eluting beads transarterial chemoembolization.

To evaluate pathologic, imaging, and technical predictors of therapy response in patients with hepatocellular carcinoma (HCC) within the Milan criteria undergoing doxorubicin drug-eluting beads transarterial chemoembolization (DEB-TACE) before orthotopic liver transplantation (OLT). This prospective study included consecutive patients with HCC who underwent DEB-TACE before OLT. Tumor histologic necrosis on liver explants was utilized as the standard of reference to categorize treated HCCs as group 1 (>50 % necrosis) or group 2 (≤50 % necrosis). DEB-TACE technique, histological factors, and imaging evaluation utilizing the modified Response Evaluation Criteria in Solid Tumors (mRECIST) were compared between groups 1 and 2. Twenty-seven HCCs were identified in 23 patients. Group 1 comprised 18 HCCs (mean necrosis 86.2 %). Group 2 comprised 9 HCCs (mean necrosis 31.1 %). The mean time between the last DEB-TACE session and the OLT was 112days. Lesion size was significantly larger in group 1 (mean 3.2cm; 95 % confidence interval 2.55-3.85) than in group 2 (mean 2.1cm; 95 % confidence interval 1.79-2.48) (p = 0.030). Group 1 also demonstrated a higher frequency of encapsulated lesions when compared to group 2 (78 % vs. 22 %; p = 0.0027). A significant linear correlation was found between the quantification of necrosis by imaging and pathology (p = 0.0011) using the mRECIST, with a poorer correlation index in group 2. Larger and encapsulated HCCS are associated with a higher percentage of necrosis. A significant linear correlation between the amount of necrosis by imaging and pathology was encountered when mRECIST was utilized.

Erratum to: Safety and Efficacy of a Circumferential Clip-Based Vascular Closure Device in Cirrhotic and Coagulopathic Patients with Hepatocellular Carcinoma After Doxorubicin Drug-eluting Beads Transarterial Chemoembolization

Erratum to: Safety and Efficacy of a Circumferential Clip-Based Vascular Closure Device in Cirrhotic and Coagulopathic Patients with Hepatocellular Carcinoma After Doxorubicin Drug-eluting Beads Transarterial Chemoembolization

Safety and Efficacy of a Circumferential Clip-Based Vascular Closure Device in Cirrhotic and Coagulopathic Patients with Hepatocellular Carcinoma After Doxorubicin Drug-eluting Beads Transarterial Chemoembolization

This study was designed to investigate the safety and efficacy of the circumferential clip-based (StarClose) vascular closure device (VCD) in coagulopathic and cirrhotic patients with hepatocellular carcinoma (HCC) after doxorubicin drug-eluting beads transarterial chemoembolization (DEB TACE). Consecutive cirrhotic patients with HCC, who underwent DEB TACE from November 2009 to February 2012, were included in the study. Based on platelet count (PC) and international normalized ratio (INR), these patients were further divided into group A (PC ≥ 150 k/dl), B (PC = 50-149 k/dl), C (PC < 50 k/dl), D (INR ≤ 1.2), E (INR = 1.21-1.5), and F (INR > 1.5). StarClose VCD was attempted in each case. Technical success was defined as complete hemostasis achieved within 3 min after the closure. Periprocedural complications were studied. A total of 350 DEB TACEs were performed in 195 patients (mean age 61.6 years, SD 9.1). StarClose VCD was attempted in all cases. StarClose device was not deployed in 2.2 % (8/350) of cases due to improper femoral punctures and severe atherosclerotic disease. Technical success rate was 97.1 % (332/342). All groups (A-F) were similar in age, sex, body mass index, and technical success rate (P > 0.05). Minor complications occurred after 1.8 % (6/342) of cases. VCD was repeatedly used in 92 patients with 96.2 % (230/239) of technical success rate. There was no major complication related to VCD. There was no access site infection, leg ischemia, and pseudoaneurysm or symptomatic groin hematoma. Circumferential clip based (StarClose) arterial closure device achieved effective and rapid hemostasis after DEB TACE with minimal complications in cirrhotic patients with HCC and coagulopathy. StarClose deployment and reaccess in patients with PC < 50 k/dl and INR > 1.2 are safe and effective.

Update with longitudinal analysis of quality of life assessment after doxorubicin drug-eluting beads transarterial chemoembolization (DEB TACE) in patients with hepatocellular carcinoma (HCC)

Update with longitudinal analysis of quality of life assessment after doxorubicin drug-eluting beads transarterial chemoembolization (DEB TACE) in patients with hepatocellular carcinoma (HCC)

Abstract No. 241 - Vascular lakes after doxorubicin drug eluting beads chemoembolization

Purpose To evaluate the significance of focal contrast extravasation (vascular lakes) in the tumor bed after 100 to 300 μm doxorubicin drug eluting beads (DEB) transarterial chemoembolization. Materials and Methods 72 consecutive patients (47 males, mean age 62 years, range 37 to 52) with unresectable hepatocellular carcinoma (HCC) underwent 90 DEB transarterial chemoembolizations. 69 DEB transarterial chemoembolizations were segmental and 21 were lobar. 13 patients had multifocal, 10 had diffuse/ infiltrative and 49 had focal tumors. The diameter of the treated lesions ranged from 20 to 84 mm (mean 36.1). 58 patients had one chemoembolization, and 14 had two or more chemoembolizations. Final hepatic arteriogram showed forward flow in 86 sessions and stasis in 4. Patients who were found to have vascular lakes after chemoembolization were identified and analyzed. Results In 13% (12/ 90) of DEB transarterial chemoembolizations, vascular lakes were noted on post chemoembolization angiograms. In this group, 3 chemoembolizations were lobar and 9 were segmental to treat diffuse/infiltrative tumors in 2, multifocal in 2 and focal in 8 patients. The mean diameter of the treated tumor in this group was 49 mm, range 25 to 70 mm (p0.0048). In 1 patient the vessel feeding the vascular lake was coil embolized. 10 patients were discharged the next day after chemoembolization. 1 patient was discharged the same day. 1 patient was discharged two days after the procedure. 7 of 12 patients did not have further treatment and 5 patients had follow up treatments with chemoembolization. On follow up chemoembolization, 5 of 5 patients had no vascular lakes on hepatic angiogram. On follow up post treatment MRI, all 12 patients with history of vascular lakes had treatment response with decrease in size and enhancement of the tumor. Conclusion Tumor vascular lakes are a relatively common finding seen on hepatic angiograms after DEB transarterial chemoembolization. These vascular lakes appear to be a transient finding without significant side effects and associated to tumor response.

MRECIST and EASL responses at early time point by contrast-enhanced dynamic MRI predict survival in patients with unresectable hepatocellular carcinoma (HCC) treated by doxorubicin drug-eluting beads transarterial chemoembolization (DEB TACE)

BackgroundWe analyzed the magnetic resonance imaging (MRI) responses by world health organization (WHO), response evaluation criteria in solid tumor (RECIST), European Association for the Study of Liver (EASL), and modified RECIST (mRECIST) guidelines and correlated with survival after doxorubicin (Adriamycin; Pharmacia & Upjohn, Peapac, NJ). drug-eluting beads transarterial chemoembolization (DEB TACE) in patients with unresectable hepatocellular carcinoma (HCC). Patients and methodsThe early target and overall imaging responses were studied in 120 consecutive patients treated with DEB TACE for unresectable HCC, using RECIST, WHO, EASL, and mRECIST guidelines on contrast-enhanced dynamic liver MRI. The median period between the DEB TACE and assessment scan was 33.50 days. Survival analyses were carried out with the Kaplan–Meier method and the Cox proportional model. ResultsWHO and RECIST1.1 had poor correlation with survival. mRECIST and EASL had significant correlation with survival with target lesion response rates of 63.3% and 48.3% and with overall response rates of 52.5% and 39.2%, respectively. The responders of EASL and mRECIST had significant median survival (P ≤ 0.0001). Moreover, mRECIST was better than EASL in predicting survival, because the survival difference between responders and non-responders of overall response was statistically significant (P = 0.013) for mRECIST, but not for EASL (P = 0.064). ConclusionsEASL and mRECIST responses measured on MRI at an early time point after DEB TACE predicted survival. mRECIST response demonstrated higher survival correlation than EASL.

Abstract No. 324 - Update with longitudinal analysis of quality of life assessment after doxorubicin drug-eluting beads transarterial chemoembolization (DEB TACE) in patients with hepatocellular carcinoma (HCC)

Purpose To investigate the effects on health-related quality of life after doxorubicin DEB TACE in patients with HCC Materials and Methods Single-center IRB-approved prospective health-related quality of life (HRQOL) study with analysis of the Short-Form 36 (SF-36) assessment tool before and after DEB TACE. Scores prior to DEB TACE along with post-treatment, 6-month, and 12-month follow-up scores were obtained. Paired t-test was used to compare the score of each domain before and after treatment. Significance levels were set at .05 for all tests. The SAS statistical package v9.3 (SAS Institute, Inc., Cary, NC) was used for all data management and analyses Results 114 patients with HCC (81 males, 33 females median age 60 years range 24-88) were enrolled into the study. 33 patients have completed 6-month follow-up surveys and 21 patients have completed 12-month follow-up surveys. Patients had decreased baseline scores within all eight domains of the SF-36 compared with healthy age-adjusted norms. There were positive trends in the role-emotional (46.96 vs 54.17, p=0.08), mental health (66.56 vs 68.1, p=0.49), and Social Functioning (58.26 vs 58.58, p=0.89) domains after therapy, although not statistically significant. There were no significant changes in the physical functioning (50.11 vs 48.23, p=0.38), pole-physical (35.49 vs 28.63, p=0.08), vitality (40.27 vs 38.58, p=0.27), bodilypPain (55.93 vs 53.71, p=0.39), and general health (44.92 vs 43.68, p=0.43) domains. There were no significant changes in any domain six months after therapy, although a positive trend in Bodily Pain (51.89 vs 59.85, p=0.06) almost reached significance. There were no significant changes in any domain twelve months after therapy. Longitudinal analysis revealed no significant changes when comparing short-term follow-up (1-3 month) with either 6 or 12-month scores, and no significant change between 6 and 12-month scores Conclusion Patients with HCC are not likely to perceive decreases in any of the HRQOL domains after treatment with DEB TACE

Safety and Efficacy of Doxorubicin Drug-eluting Bead Transarterial Chemoembolization in Patients with Advanced Hepatocellular Carcinoma

PurposeTo investigate the safety and efficacy of transarterial chemoembolization using doxorubicin drug-eluting beads (DEBs) in patients with Barcelona Clinic Liver Cancer (BCLC) C stage hepatocellular carcinoma (HCC). MethodsConsecutive patients with initial staging of BCLC C HCC who received DEB transarterial chemoembolization over the last 5 years were studied. The study included 121 patients (mean age, 61.2 years old). Adverse events (AEs) after DEB transarterial chemoembolization were studied in detail and were recorded as per the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 criteria. Survivals were analyzed according to parameters from the time of first DEB transarterial chemoembolization. Kaplan-Meier method by log-rank test and Cox proportional hazard model were used for survival analysis. ResultsAEs occurred in 30.2% of patients. No AEs were greater than Common Terminology Criteria for Adverse Events grade III. Grade I and II AEs included nausea and vomiting in 7.8% of patients and abdominal pain in 23.8% of patients. Grade III AEs were noted in 1.06% of patients. There were no gastrointestinal or hepatic complications. There were no deaths within 30 days after DEB transarterial chemoembolization. The overall median survival was 13.5 months. Among the Child-Pugh class A patients, those without PVT and metastasis (28.9%) had better survival when treated with DEB transarterial chemoembolization than those with PVT and metastases (9.9%) (18.8 mo versus 4.4 mo, P = .001). Ascites, performance status, Okuda stage HCC, serum alpha fetoprotein levels, and etiologic factor for chronic liver disease predicted survival. ConclusionsDEB transarterial chemoembolization appears to be a safe and effective treatment option for patients with BCLC C HCC. Patients with Child-Pugh class A without PVT and metastasis benefited most from DEB transarterial chemoembolization.

Abstract No. 213: Quality of life assessment after doxorubicin drug-eluting beads transarterial chemoembolization (DEB TACE) in patients with hepatocellular carcinoma (HCC)

Abstract No. 213: Quality of life assessment after doxorubicin drug-eluting beads transarterial chemoembolization (DEB TACE) in patients with hepatocellular carcinoma (HCC)