Effect Of Transarterial Chemoembolization Research Articles

Arterial-Portal Venous Shunt after Drug-Eluting Bead Transarterial Chemoembolization for Hepatocellular Carcinoma Patients: Risk factors and Impact on Patient Survival

Introduction: The effectiveness of transarterial chemoembolization (TACE) in treating hepatocellular carcinoma (HCC) has been well established. The differential impacts of drug-eluting bead TACE (DEB-TACE) as opposed to conventional TACE (cTACE) on vascular changes, such as arterial-portal venous shunts (APSs), have been recognized. However, their subsequent effects on treatment outcomes have not been fully explored. This study aims to identify risk factors associated with the occurrence of APS in HCC patients treated with DEB-TACE and to evaluate its impact on patient survival. Methods: A retrospective analysis was conducted from January 2012 to December 2018 including 74 HCC patients receiving DEB-TACE as initial treatment and a 1:1 cTACE. Kaplan-Meier analysis estimated overall survival (OS) and progression-free survival (PFS). Logistic regression identified significant risk factors for APS occurrence after DEB-TACE. Results: APS incidence was significantly higher after DEB-TACE than cTACE (46.0% vs. 16.2%, p p = 0.111; median PFS was 15.6 months (4.1–27.1) and 9.5 months (6.8–12.1) for the two groups, respectively, p = 0.065. Risk factors for APS occurrence after DEB-TACE were more than two feeding arteries (OR: 7.25, 95% CI: 1.82–28.95, p = 0.005) and non-selective embolization (OR: 8.02, 95% CI: 2.30–27.95, p = 0.001). Conclusion: APS occurrence was higher in DEB-TACE-treated HCC patients, but it did not significantly affect OS and PFS. More than two feeding arteries and non-selective embolization were significant risk factors for APS occurrence after DEB-TACE.

A commentary on 'Effect of transarterial chemoembolization as postoperative adjuvant therapy for intermediate stage hepatocellular carcinoma with microvascular invasion: a multicenter cohort study'.

A commentary on 'Effect of transarterial chemoembolization as postoperative adjuvant therapy for intermediate stage hepatocellular carcinoma with microvascular invasion: a multicenter cohort study'.

Safety and Effectiveness of Transarterial Chemoembolization in Hepatocellular Carcinoma Patients Aged Greater versus Less Than 80 Years.

Population aging has emerged as a pressing global concern and a significant medical challenge. The use of transarterial chemoembolization (TACE) has been extensively employed for managing unresectable hepatocellular carcinoma (HCC). However, there is limited evidence regarding the safety and effectiveness of TACE specifically in individuals aged 80 years and above. To examine the safety and effectiveness of TACE in elderly patients (≥ 80 years) compared to younger patients (< 80 years) with HCC, and the potential risk factors that may impact the progression-free survival (PFS) for TACE were also identified. A retrospective analysis was conducted on a consecutive cohort of unresectable HCC patients who were initially treated with TACE. The patients were categorized into two groups based on the age at which they underwent TACE, and the efficacy and safety of the treatment were evaluated. The PFS was investigated, and the prognostic factors were analyzed using the Kaplan-Meier method and Cox proportional hazard models. A total of 198 patients were included in this study, with 44 patients aged 80 years or older and 154 patients younger than 80 years. The cumulative risk of PFS after TACE was similar between the two groups (P = 0.800). In the multivariate analysis, a lower ECOG score (P = 0.039) and an earlier BCLC stage (P = 0.004) were identified as independent predictors of better PFS. Patients in both groups tolerated the TACE treatment well. The impact of aging on poor PFS is not significant. In patients with HCC, TACE therapy is both safe and effective for octogenarians, similar to younger patients. Furthermore, the better PFS is associated with a low ECOG score and an early BCLC stage.

HIF-1α and VEGF as prognostic biomarkers in hepatocellular carcinoma patients treated with transarterial chemoembolization

BackgroundNeoangiogenesis plays a crucial role in the progression of hepatocellular carcinoma (HCC), and concerns have been raised about the role of neoangiogenesis on the effectiveness of transarterial chemoembolization (TACE). AimIn this study, we aimed to evaluate Vascular Endothelial Growth Factor (VEGF) and Hypoxia-Inducible Factor-1α (HIF-1α) as circulating prognostic biomarkers in HCC patients treated with TACE. MethodsBlood samples were collected from 163 patients before (t0) and four weeks after TACE (t1). ResultsHigher levels of VEGF after TACE were demonstrated (264.0 [78.7–450.8] vs. 278.6 [95.0–576.6] pg/mL; p < 0.0001). Responders to TACE had lower levels of VEGF than non-responders both at t0 (200.0 [58.9–415.8] vs. 406.6 [181.4–558.6] pg/mL; p = 0.006) and at t1 (257.3 [68.5–528.6] vs. 425.9 [245.2–808.3] pg/mL; p = 0.003), and in both groups there was an increase in VEGF compared to measurements before treatment (p = 0.001 and p = 0.005, respectively). VEGF was not associated with overall survival (OS), while patients with HIF-1α ≤ 0.49 ng/mL showed better prognosis (median OS 28.0 months [95% CI 19.7–36.3] vs. 17.0 months [95% CI 11.1–22.9]; p = 0.01). Moreover, HIF-1α was identified as an independent prognostic parameter. ConclusionsVEGF and HIF-1α can be considered useful prognostic biomarkers in HCC patients treated with TACE.

Efficacy of TACE Combined with Lenvatinib Plus Sintilimab for Hepatocellular Carcinoma with Tumor Thrombus in the Inferior Vena Cava and/or Right Atrium.

To validate the safety and effectiveness of transarterial chemoembolization (TACE) combination with lenvatinib and sintilimab in treating hepatocellular carcinoma (HCC) patients with inferior vena cava (IVC) and/or right atrium (RA) tumor thrombosis (TT). This study retrospectively analyzed HCC patients with IVC and/or RA TT treated with TACE combined with lenvatinib plus sintilimab. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) were calculated to evaluate the anti-tumor efficacy. Treatment-related adverse events (TRAEs) were analyzed to assess the safety profiles. A total of 58 patients were screened for eligibility between March 2019 and May 2022. At the time of data collection, 48.2% of patients were still receiving treatment. The median follow-up was 23.5 months. The ORR was 48.3%, the DCR was 91.4%, the median OS was 17.3 months, and the median PFS was 13.0 months. The ORR for IVC/RA TT was 62.1%, DCR was 94.9%, and the median PFS was 14.3 months. 56.9% of patients experienced ≥ grade 3 TRAEs, such as hypertension (10.3%) and elevated liver enzymes (13.8%). No new safety signals were identified. Participants with low levels of serum PCT value had satisfactory prognoses. TACE combination with lenvatinib plus sintilimab is effective in treating HCC with IVC and/or RA TT. The toxicities were manageable, with no unexpected safety signals. The baseline levels of serum PCT might be the predictive biomarkers for the triple combination therapy.

Correlation of Serum Chemokine Ligand 14 with Barcelona Clinic Liver Cancer Stage, Lymphocyte Profile, and Response to Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma

PurposeTo investigate the clinical relevance of serum chemokine ligand 14 (sCCL14) in patients with hepatocellular carcinoma (HCC) and the effect of transarterial chemoembolization (TACE) on the expression level of sCCL14 and the immune microenvironment. Materials and MethodsIn this prospective single-center observational study, 52 patients with HCC were recruited from January 2019 to December 2021, their clinical data and blood samples were collected, and the relationship between sCCL14 and progression-free survival (PFS) and TACE treatment response was analyzed. ResultsAmong the 52 patients with HCC (Barcelona Clinic Liver Cancer [BCLC] Stage A, 25.0%; BCLC Stage B, 44.2%; and BCLC Stage C, 30.8%), patients with BCLC Stage C HCC had significantly lower sCCL14 levels than those of patients with BCLC Stages A and B HCC (P = .001). sCCL14 levels were significantly higher in the first week after treatment than before TACE treatment (P = .024). Baseline sCCL14 levels in patients who showed complete response after TACE treatment were significantly higher than those in other groups, and lower baseline sCCL14 values were associated with shorter PFS times. Multivariate Cox regression analysis showed that sCCL14 level (hazard ratio, 1.855; 95% CI, 1.039–3.311; P = .037) was an independent prognostic factor of PFS. sCCL14 levels negatively correlated with the proportion of B lymphocytes and regulatory T cells in circulating blood and positively correlated with the absolute T-lymphocyte count. ConclusionssCCL14 may be a predictive biomarker of TACE effectiveness. Further studies are needed to validate and outline the role of combination immunotherapy.

Abstract 2460: Assessing the effectiveness of transarterial chemoembolization using super-resolution ultrasound imaging and a rat model of hepatocellular carcinoma

Abstract Introduction: Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related deaths worldwide. Transarterial chemoembolization (TACE) treatment of HCC restricts the blood supply to the tumor. Conventional assessment of tumor response is performed by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) or computed tomography (DCE-CT) at 4 to 6 weeks after the TACE procedure. An earlier indication of treatment effectiveness would improve patient management and prognosis. Super-resolution ultrasound (SR-US) imaging allows a ten-fold improvement in spatial resolution compared to traditional ultrasound (US) and allows visualization of microvascular networks. The goal of this preclinical research study was to use SR-US imaging to assess the effectiveness of TACE treatment in a relatively brief time frame. Methods: Eight male Sprague Dawley rats weighing around 300 g were injected with 5 million N1S1 cells in the upper left liver lobe and the tumors were allowed to grow for 14 days. The TACE procedure consisted of transhepatic arterial delivery of a mixture of 25 µL Lipiodol and 25 µL Doxorubicin (10 mg/kg) via a polyethylene microcatheter. After intravenous injection of a microbubble (MB) contrast agent, contrast-enhanced US images were acquired (N = 3000) with a preclinical system (Vevo 3100, FUJIFILM VisualSonics Inc) equipped with an MX201 linear array transducer. US images were processed to remove high motion frames, followed by tissue suppression filtering, and then MB localization and accumulation. Morphological filtering was used to enhance the vessel structures. In vivo US, MRI, and CT imaging were performed at baseline before TACE and again at 1 and 2 wk. After euthanasia, tumor tissue was removed for ex vivo analysis. Results: A rat model of HCC for assessing TACE treatment was introduced. Based on tumor size changes and residual perfusion after the TACE procedure, treatments were determined to be a complete responder, partial responder, or non-responder. Initial results demonstrate that SR-US imaging can sensitively detect any reduction in HCC perfusion as measured by a microvascular density (MVD) metric within 2 wk after a single TACE procedure. MVD measurements from the SR-US images were consistence with tumor volume data from MRI and CT imaging. Conclusions: In vivo SR-US images of tumor microvascular networks provided insight into treatment efficacy. Citation Format: Junjie Li, Katherine Brown, Megan Yociss, John Eisenbrey, Kenneth Hoyt. Assessing the effectiveness of transarterial chemoembolization using super-resolution ultrasound imaging and a rat model of hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2460.

I-125 seeds brachytherapy with transcatheter arterial chemoembolization for subcapsular hepatocellular carcinoma

BackgroundI-125 seeds brachytherapy (ISB) has been used to improve the clinical effectiveness of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). We aim to appraise the safety and clinical efficacy of combined ISB and TACE for the treatment of subcapsular HCC.Materials and methodsA retrospective investigative study extending from January 2017 to December 2020, involved individuals suffering from subcapsular HCC, who were subjected to TACE treatment with or without ISB in our center. The clinical effectiveness was compared between 2 groups.ResultsSixty-four patients, in total, with subcapsular HCC had to undergo TACE with (n = 32) or without (n = 32) ISB in our center. After CT-guided ISB, only 2 (6.3%) patients experienced a self-limited pneumothorax. Combined treatment resulted in a significantly higher complete response (56.3% vs. 18.8%, P = 0.002) and total response (90.7% vs. 59.4%, P = 0.004) rates than that of TACE alone. In comparison to the TACE alone group, the median progression-free survival was substantially longer in the combined treatment group (11 months vs. 5 months, P = 0.016). Further, 15 and 28 patients in combined and TACE alone groups respectively died within the follow-up. The median OS was comparable between combined and TACE alone groups (22 months vs. 18 months, P = 0.529).ConclusionsCombined TACE and ISB therapy is a safe treatment method for individuals suffering from subcapsular HCC. When compared, combined treatment had significantly enhanced clinical efficacy as a subcapsular HCC therapy, in comparison to TACE alone.

Low applicability of the ''Six-and-twelve score" in hepatocellular carcinoma treated with Drug-Eluting Beads Transarterial Chemoembolization.

The effectiveness of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) depends on the selection of suitable patients. The ''Six-and-twelve score" distinguishes three groups of ideal patients with different overall survival, based on the sum of the number and size of tumors. This may impact on clinical practice and trial design. The aim of this study was to assess the reproducibility and prognostic value of the model in western patients treated with Drug-Eluting Beads (DEB)-TACE. Observational, retrospective, unicentric study with consecutive compensated patients treated with DEB-TACE from October 2008 to October 2017. Exclusion criteria were Child-Pugh ≥ 8 and DEB-TACE used as a bridge to liver transplantation. 225 HCC consecutive patients were included; BCLC-0/A n=131 (single nodules > 5, n=29) and BCLC-B n=94. The median overall survival (OS) was 27 months (95% CI 23.8-30.2). OS was different between BCLC-0/A vs BCLC-B: 30 vs 24 months (p= 0.03), Child-Pugh A5 vs A6-B7: 30 vs 27 months (p= 0.003). ''Six-and-twelve score" groups discriminated OS: group 1, n=123, 32 months (95% CI 27.5-63.5), group 2, n=101, 24 months (95% CI 19.6-28.4) and group 3, n=1, 27 months (p=0.024). When comparing the three scores, the ''Six-and-twelve score" showed the best discrimination power: C-index 0.603, Akaike's information criterion (AIC) 1.642, likelihood ratio test (LRT) 16.21. The ''Six-and-twelve score" is a prognostic tool for patients with HCC treated with DEB-TACE. However, few patients were included in the third group (score >12) and no differences were observed with BCLC, therefore its applicability is limited. .

The effectiveness of transarterial chemoembolization in metastatic uveal melanoma of the liver

Aim: to study the effectiveness of the use of transarterial chemoembolization (TACE) in the treatment of patients with metastatic uveal melanoma. Material and methods: in N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia in the period from 2000 to 2019 72 patients received treatment (TACE) for metastases of uveal melanoma in the liver. Of these: men – 22 (30,6%), women – 50 (69,4%). Average age 46,28±10,32 years, range 23–84 years. The time of detection of metastatic liver lesions after treatment of the primary tumor ranged from 2 to 252 months, the median was 24 months. The volume of liver damage was up to 25% in 19 patients, from 25% to 50% in 33 patients, from 50% to 75% in 20 patients. A total of 134 TACE interventions were performed. Depending on the volume of the lesion, the nature of the blood supply to the tumors and the response to treatment, patients underwent 1 to 5 sessions of TACE: in 27 patients one TACE, in 35 – two, in 5 – three, in 3 – four, and in 2 – five TACE. As an embolizing component, lipiodol 10 ml was used in 106 cases, microspheres in 16 cases (particle sizes varied from 100 to 500 μm), in 12 TACEs, combinations of the presented embolizing materials were used. Carboplatin, doxorubicin or gemcitabine were used as chemotherapy drugs. Results: 58 patients (80,6%) had a moderate postembolization syndrome, expressed by pain, febrile temperature, nausea, and vomiting. A local response (including complete response, partial response, or stabilization by mRECIST criteria) was observed in 53/72 (73,6%) patients with metastases of uveal melanoma. The duration of observation of patients after TACE was from 2 to 60 months. The median follow-up was 12,5 months. The group that responded to treatment, including stabilization, achieved a 1-year Kaplan-Meier overall survival rate of 72% and a 2-year rate of 45,6%. In patients with continued growth of lesions, the 1-year overall survival rate according to the Kaplan-Meier method was 42,6%, and the 2-year survival rate was not achieved. 48 patients were alive at the time of the study, 24 died from disease progression. Conclusions: the use of TACE in metastatic lesions of the liver by choroidal melanoma in combined treatment or in mono-regimen led to an objective response or stabilization of the process in 73,6% of patients. This method increases the overall survival of patients and is well tolerated.

Celecoxib versus parecoxib versus oxycodone in pain control for transcatheter chemoembolization in patients with hepatocellular carcinoma.

509 Background: Abdominal pain is one of the most common side effects of transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma. Previous studies reported that perioperative controlled-release oxycodone (CRO) intake or administration of parecoxib resulted in adequate pain control after TACE. However, there are currently no studies comparing opioids with nonsteroidal anti-inflammatory drugs (NSAIDs) in controlling postoperative pain. Therefore, we conducted a clinical trial to compare the analgesic effect and safety among celecoxib (oral COX-2 inhibitor), parecoxib (injectable COX-2 inhibitor), and CRO (oral opioids) in patients undergoing TACE. Methods: The study was a prospective, randomized, paralleled trial in which 213 patients were enrolled between September 2016 and March 2019. Patients were randomly assigned at the ratio of 1:1:1 to receive celecoxib, parecoxib or CRO 1 h before TACE (T0) and once every 12 h for 2 days after TACE. Pain level, morphine consumption and adverse events were evaluated and compared among the three regimens. Results: Highest incidence of pain occurred within the first 12 hours (T12) after TACE. Analysis of pain control showed no significant difference among the mean highest pain scores, percentage distribution of pain categories and mean morphine consumption in the three groups at T0, T12, T24, T36, and T48. At T24, 11 patients (15.7%) in oxycodone group had fever, which was higher than parecoxib regimen (1 patient [1.5%], P = 0.003). At T36, 13 patients (18.6%) in oxycodone regimen had fever, which was higher than celecoxib regimen (2 patients [2.9%], P = 0.003) and parecoxib regimen (1 patient [1.5%], P &lt; 0.001). At T48, 11 patients (15.7%) in oxycodone regimen had fever, which was higher than celecoxib regimen (2 patients [2.9%], P = 0.010) and parecoxib regimen (0 patients, P = 0.001). Conclusions: The results suggested that patients obtained celecoxib, parecoxib or CRO once every 12 hours can have the same level of analgesic effect during each time period of TACE. However, body temperature balance in oxycodone regimen was significantly worse than celecoxib regimen and parecoxib regimen. Clinical trial information: NCT03059238.

Effect of Transarterial Chemoembolization in Hepatocellular Carcinoma with Respect to Tumor Size: A Prospective Observational Study

Hepatocellular carcinoma is ranked as the sixth most common cancer globally. It also accounts for the second leading determinant of cancer-related mortalities worldwide. In the present day, transarterial chemoembolization (TACE) is the treatment modality of preference for high burden hepatocellular carcinoma. Our study aims to report the efficacy of TACE and alterations in laboratory parameters in patients of hepatocellular carcinoma before and after undergoing TACE in lieu with size >3 cm or <3 cm of the tumor. This prospective observational study was prosecuted in medicine, gastroenterology and hepatology department including 167 patients who were previously diagnosed with hepatocellular carcinoma by radiological imaging, and have undergone TACE. The mean age of the study population is 53.89 ± 10.58 with females elder than males (p=0.038). The most frequent cause was Hepatitis C (p<0.001). Total bilirubin was found more in <3 cm tumor size (p=0.052) while decreased platelets were more a feature of >3cm tumor size (p=0.050). After TACE, bilirubin levels were remarkably improved in <3 cm tumor size, while INR and Platelets equally improved in both the groups and serum albumin and serum sodium was comparatively more improved in >3cm tumor size. Serum creatinine worsened in <3cm tumor size while improved in >3 cm tumor size, and SGPT was indifferent in <3cm tumor size and worsened in >3cm tumor size. Mean meld score was found improved in both the study groups however, greater improvements were seen in >3cm tumor size group. Downstaging of child-pugh classes was statistically significant in both the study groups (p<0.001).

Short‐ and long‐term effects of transarterial chemoembolization on portal hypertension in patients with hepatocellular carcinoma

BackgroundTransarterial chemoembolization (TACE) affects hepatic perfusion, and might have an impact on portal pressure in patients with hepatocellular carcinoma (HCC).ObjectiveThe objective of this article is to report the secondary outcome “hepatic hemodynamics” from the AVATACE trial, a prospective randomized, placebo-controlled trial on the efficacy of conventional TACE in combination with bevacizumab or placebo.MethodsHepatic venous pressure gradient (HVPG) was measured at baseline (prior to first TACE), within nine days (“acute effects”), two months (“intermediate effects”) and six months (“long-term effects”) after the first TACE.ResultsOf 28 patients with early-intermediate stage HCC, n = 20 (71%) had clinically significant portal hypertension (CSPH, HVPG ≥ 10 mmHg) at baseline (median, 12 (interquartile range (IQR): 9–19) mmHg). TACE had neither “acute effects” nor “intermediate effects” on HVPG. However, in 13 patients with available HVPG measurement at month 6, there was a significant increase in HVPG (median, 16 (IQR: 11–19) mmHg) compared with baseline (median, 10 (IQR: 5–12) mmHg; p = 0.007). Portal hypertension-related complications occurred exclusively in patients with CSPH (8 (40%) vs 0).ConclusionsRepeated TACE was associated with a significant long-term increase in HVPG. This should be considered when deciding whether to continue with TACE or switch to systemic treatment, since CSPH drives the development of complications.

SAT-486-Short- and long-term effects of transarterial chemoembolization on portal hypertension in patients with hepatocellular carcinoma

SAT-486-Short- and long-term effects of transarterial chemoembolization on portal hypertension in patients with hepatocellular carcinoma

Oncologic effectiveness of transarterial chemoembolization in local control of large hepatocellular carcinoma.

e16148Background: To evaluate the oncologic effectiveness of Transarterial chemoembolization (TACE) in Local control of hepatocellular carcinoma (HCC) up to 7cm. Methods: We reviewed our institutio...

Effect of transarterial chemoembolization plus external beam radiotherapy on survival of patients with hepatocellular carcinoma showing macroscopic vascular invasion compared with sorafenib: A randomized trial.

210 Background: Sorafenib is the sole treatment option for advanced stage hepatocellular carcinoma (HCC) with macroscopic vascular invasion (MVI) with unsatisfactory response rate and survival benefit. Combined transarterial chemoembolization (TACE) plus external beam radiotherapy (RT) has shown promising results in these patients by observational studies. Here, we report the efficacy and safety of TACE plus RT compared to sorafenib in patients with advanced HCC and MVI. Methods: This study was a randomized, open-label trial at an academic tertiary care center. Between 2013 and 2016, 90 treatment-naive patients with liver-confined HCC showing MVI were randomly assigned to receive sorafenib (400 mg twice-daily; n = 45; sorafenib group) or TACE (every 6 weeks) plus RT (within 3 weeks after the first TACE; n = 45; TACE+RT group). Primary endpoint was 12-week the progression-free survival (PFS) rate by intention-to-treat analysis. Radiologic response was assessed by independent review according to Response Evaluation Criteria in Solid Tumors (version 1.1). Crossover of treatment was permitted after confirming disease progression. Results: All patients had portal vein invasion of HCC and Child-Pugh class A liver function. The median maximal tumor diameter was 9.7 cm. At week 12, the PFS rate was significantly higher in the TACE+RT group than the sorafenib group (77.8% vs. 26.7%; P&lt; 0.001). The TACE+RT group showed significantly higher radiologic response rate (33.3% vs. 2.2% at 24 weeks; P&lt; 0.001), significantly longer median time to disease progression (30 weeks vs. 8 weeks; P&lt; 0.001), and significantly longer overall survival (55 weeks vs. 43 weeks; P= 0.04), compared with the sorafenib group. No patients in the TACE+RT group discontinued treatment due to hepatic decompensation. Conclusions: In patients with advanced HCC showing MVI, first-line treatment with TACE+RT was well-tolerated and provided improved progression-free survival, objective response rate, time to disease progression, and overall survival, compared with sorafenib treatment. Clinical trial information: NCT01901692.

The Effect of Transarterial Chemoembolization in Combination With Kang'ai Injection on Patients With Intermediate Stage Hepatocellular Carcinoma: A Prospective Study.

Background: The outcome of patients with intermediate stage hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE) remains poor. Search for a more effective therapy is still necessary. Objective: This study aimed to investigate the effect of combining TACE with Kang’ai (KA) injection for treating patients with intermediate stage HCC. Methods: A total of 89 patients with intermediate stage HCC were enrolled and divided into TACE +KA group (n = 48) receiving repeated TACE plus KA injection, and TACE group (n = 41) receiving repeated TACE alone. All patients were prospectively studied. Primary endpoints were overall survival (OS) and time to radiologic progression (TTP). Results: The TACE + KA group had significantly longer median OS (27.0 vs 21.0 months, P = .038) and TTP (12.0 vs 10.0 months, P = .028) than TACE group. The 1-, 2-, and 3-year OS rates in the TACE + KA group were markedly higher than in TACE group (88.5%, 58.8%, and 20.8% vs 81.3%, 44.9%, and 6.7%, respectively, P = .038), while the 1- and 2-year TTP rates in the TACE + KA group were significantly lower than in TACE group (49.3% and 86.9% vs 75.3% and 100%, P = .028). TACE + KA group displayed significantly lower incidences of intrahepatic and extrahepatic metastases, as well as postembolization syndrome than TACE group (P < .05). Multivariate analyses revealed group (P = .023), maximum tumor size (P = .019), and tumor number (P = .034) as significant predictors for OS, and group (P = .046), maximum tumor size (P = .002) and α-fetoprotein level (P = .020) as significant predictors for TTP. Both TACE and KA injection were well tolerated. Conclusion: TACE plus KA injection is more effective than TACE alone for treating patients with intermediate stage HCC in this nonrandomized study. Further research is warranted.

Transarterial chemoembolization combined with Jie-du granule preparation improves the survival outcomes of patients with unresectable hepatocellular carcinoma.

The aim of the present study was to compare the effectiveness of transarterial chemoembolization (TACE), TACE combined with Jie-du granules (JD), and TACE combined with sorafenib (SOR) for treating patients with unresectable hepatocellular carcinoma (HCC). For this purpose, we conducted a retrospective analysis of data from 266 consecutive patients with unresectable HCC who underwent TACE treatment at the Shanghai Hospital and Eastern Hepatic Surgery Hospital between Jan 2009 and Dec 2010. We prospectively analyzed patient survival and progression times as well as independent predictors, within a follow-up period of 86 months. Patients were divided into TACE-JD (n = 75), TACE-SOR (n = 124) and TACE (n = 67) groups. Median overall survival (OS) times being: TACE-JD, 21.43 months; TACE-SOR, 23.23 months; TACE, 13.97 months (TACE-SOR vs TACE, P < 0.001; TACE-SOR vs TACE-JD, P = 0.852; TACE-JD vs TACE, P < 0.001). The median times to progression (TTP) were as follows: TACE-JD, 8.67 months; TACE-SOR, 5.37 months; TACE, 4.57 months (TACE-SOR vs TACE, P = 0.479; TACE-SOR vs TACE-JD, P < 0.001; TACE-JD vs TACE, P < 0.001). Independent predictors of OS were treatment allocation, Child-Pugh class large tumor, albumin and extrahepatic metastasis. These findings show that patients with unresectable HCC who were administered TACE-JD survived significantly longer compared with those administered TACE or TACE-SOR.

Short term effect of transarterial chemoembolization (TACE) on microsomal liver function by means of 13C-methacetin breath test (MBT) in patients with hepatocellular carcinoma (HCC)

Short term effect of transarterial chemoembolization (TACE) on microsomal liver function by means of 13C-methacetin breath test (MBT) in patients with hepatocellular carcinoma (HCC)

Transarterial Chemoembolization Using Sorafenib in a Rabbit VX2 Liver Tumor Model: Pharmacokinetics and Antitumor Effect

PurposeTo investigate feasibility, safety, and effect of transarterial chemoembolization using sorafenib on degree of tumor necrosis in a rabbit VX2 liver tumor model. Materials and MethodsNew Zealand White rabbits (n = 20) with a VX2 tumor were divided into two groups; one group was treated with hepatic arterial administration of 0.5 mL ethiodized oil alone (Lipiodol; Guerbet, Aulnay-sous-Bois, France) (transarterial embolization with Lipiodol [TAE-L] group), and one group was treated with 0.5 mL ethiodized oil plus 10 mg sorafenib (transarterial embolization with sorafenib [TAE-S] group). Liquid chromatography tandem mass spectrometry was used to measure sorafenib concentration in peripheral blood and tissue. Hepatic enzymes, vascular endothelial growth factor (VEGF), and hypoxia-inducible factor 1α (HIF-1α) were measured at 0, 24, and 72 hours after treatment. Histopathologic examination was performed to evaluate extent of tumor necrosis and normal parenchymal damage. ResultsSerum sorafenib concentration peaked at 2 hours after treatment. The mean tissue concentration was 406.8 times greater than the serum concentration. Aspartate aminotransferase and alanine aminotransferase levels were significantly elevated in the TAE-S group at 24 hours after treatment. Serum VEGF and HIF-1α concentrations were not significantly different between the TAE-L and TAE-S groups. Hepatic parenchymal damage was more severe in the TAE-S group. Mean fraction of tumor necrosis after treatment was significantly greater in the TAE-S group. ConclusionsTransarterial chemoembolization using sorafenib resulted in a high intrahepatic concentration of sorafenib. The degree of tumor necrosis was significantly greater in the TAE-S group compared with the TAE-L group, but more severe toxicity of normal liver tissue also occurred.