Initial Transarterial Chemoembolization (TACE) Using HepaSpheres 20-40 µm and Subsequent Lipiodol TACE in Patients with Hepatocellular Carcinoma > 5 cm

Su Min Cho, Hee Ho Chu, Jong Woo Kim, Jin Hyung Kim, Dong Il Gwon, Su Min Cho, Hee Ho Chu, Jong Woo Kim, Jin Hyung Kim, Dong Il Gwon

Abstract

Purpose: To investigate clinical outcomes of drug-eluting bead transarterial chemoembolization (DEB-TACE) using HepaSpheres 20-40 µm in diameter and subsequent cisplatin-based lipiodol TACE (Cis-TACE) in patients with hepatocellular carcinoma (HCC) > 5 cm.

Materials and methods: This study included 39 consecutive patients (34 men, 5 women; mean age, 63.5 years; range, 39-80 years) who underwent DEB-TACE using HepaSpheres 20-40 µm as first-line treatment for HCC > 5 cm (mean diameter, 8.2 cm; range, 5.1-13 cm) between September 2018 and August 2019. Patients with new tumors, residual tumors, or tumor growth after initial DEB-TACE underwent subsequent Cis-TACE.

Results: All 39 patients underwent initial DEB-TACE successfully, with 35 (89.7%) and three (7.7%) patients experiencing minor and major complications, respectively. After initial DEB-TACE, one patient (2.6%) achieved complete response (CR), 35 (89.7%) achieved partial response (PR), and three (7.7%) experienced progressive disease (PD). During a median follow-up period of 14.4 months (range, 0.6-23 months), 23 patients underwent Cis-TACE, with 11, three, and nine achieving CR, PR, and PD, respectively. The median overall survival time was 20.9 months (95% confidence interval (CI), 18.6-23.2 months), the median time to progression was 8.8 months (95% CI, 6.5-11.1 months), and the median time to local tumor recurrence was 16 months (95% CI, 7.4-24.6 months).

Conclusions: DEB-TACE using HepaSpheres 20-40 µm in diameter can be a safe and effective initial treatment method in patients with HCC > 5 cm. Subsequent Cis-TACE constitutes a good adjuvant method to enhance tumor response after initial DEB-TACE.

Keywords: Cis-TACE (cisplatin-based lipiodol transarterial chemoembolization); DEB-TACE (drug-eluting bead transarterial chemoembolization); hepatocellular carcinoma.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of initial tumor response after DEB-TACE and follow-up outcomes. DEB-TACE 1 = drug-eluting bead transarterial chemoembolization, CR 2 = complete response, PR 3 = partial response, PD 4 = progressive disease, Cis-TACE 5 = cisplatin-based lipiodol transarterial chemoembolization.
Figure 2
Figure 2
A 53-year-old woman who underwent DEB-TACE and one subsequent session of Cis-TACE for a single HCC 7.2 cm in size. (a) Contrast-enhanced axial computed tomography (CT) image in the arterial phase before initial DEB-TACE, showing an arterial enhancing mass in the right hemiliver. (b) Common hepatic arteriography of the patient during initial DEB-TACE, showing a hypervascular tumor in the right hemiliver. (c) Angiogram after selective embolization of the tumor-feeding arteries with HepaSpheres, showing complete devascularization of the tumor in the right hemiliver. (d) Enhanced axial CT image 5 weeks after DEB-TACE, showing PR with small residual arterial enhancement (arrow). (e) Common hepatic arteriography during subsequent Cis-TACE, showing a small enhancing lesion (arrow) in the center of the necrotic tumor. The tumor-feeding arteries were selectively embolized (not shown). (f) Enhanced axial CT image 4 weeks after subsequent Cis-TACE, showing no demonstrably enhancing portion in the liver and treated tumor, with lipiodol accumulating solely in the viable portion (arrow).
Figure 3
Figure 3
Kaplan–Meier analysis of overall survival in patients with HCCs > 5 cm who underwent DEB-TACE.
Figure 4
Figure 4
Kaplan–Meier analysis of time to progression in patients with HCCs > 5 cm who underwent DEB-TACE.

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