Skip to main content
SpringerLink
Log in

Comparison of Chemoembolization, Radioembolization, and Transarterial Ethanol Ablation for Huge Hepatocellular Carcinoma (≥ 10 cm) in Tumour Response and Long-Term Survival Outcome

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To compare transarterial chemoembolization (TACE), transarterial radioembolization using Yttrium-90 (TARE), and transarterial ethanol ablation (TEA) for huge hepatocellular carcinoma (HCC) in treatment responses and long-term survival outcomes.

Materials and Methods

In this retrospective study approved by institutional committee, inclusion criteria were tumour ≥ 10 cm, newly diagnosed, treatment naïve, Child A, Performance Score 0 or 1, no venous invasion or extrahepatic disease on contrast-enhanced CT or MRI. There were 107 patients (Supportive Care [SC] 17, TACE 54, TARE 17, TEA 19). Survival outcomes of SC and TACE were compared (TACE selected as benchmark for transarterial treatments). Tumour response and overall survival (OS) of the three groups were compared.

Results

OS of TACE (vs. SC) was significantly longer (9.9 [5.9, 24.1] months versus 2.8 [1.5, 10.2], p = 0.001). Complete response of TEA was significantly better (TEA 10/19 [52.6%] versus TARE 2/17 [12.5%], p = 0.013, versus TACE 9/54 [16.7%], p = 0.002). OS of TEA (vs. TACE) was significantly longer (21.6 [12, 41] months versus 9.9 [5.9, 24.1], p = 0.014, hazard ratio 0.6 (0.3, 1). OS of TEA (vs. TARE) was longer (21.6 [12, 41] months versus 11.9 [7, 28.7], p = 0.082, hazard ratio 0.6 (0.3, 1.3) in favour of TEA).

Conclusion

In patients with huge HCC, transarterial treatment as represented by TACE had a survival benefit over supportive care. In this retrospective analysis, TEA was associated with better tumour response and survival outcome as compared to TACE or TARE; therefore, transarterial treatment could be useful for prolonging patient survival, and TEA could be a preferred option.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Raoul JL, Sangro B, Forner A, et al. Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev. 2011;37:212–20. https://doi.org/10.1016/j.ctrv.2010.07.006.

    Article  PubMed  Google Scholar 

  2. Peng ZW, Chen SL, Wei MC, et al. Advanced recurrent hepatocellular carcinoma: treatment with sorafenib alone or in combination with transarterial chemoembolization and radiofrequency ablation. Radiology. 2018;287:705–14. https://doi.org/10.1148/radiol.2018171541.

    Article  PubMed  Google Scholar 

  3. Kok VC, Chen YC, Chen YY, et al. Sorafenib with transarterial chemoembolization achieves improved survival vs. sorafenib alone in advanced hepatocellular carcinoma: a nationwide population-based cohort study. Cancers. 2019;11:985–8. https://doi.org/10.3390/cancers11070985.

    Article  CAS  PubMed Central  Google Scholar 

  4. Salem R, Lewandowski RJ, Kulik L, et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology. 2011;140(497–507):e2. https://doi.org/10.1053/j.gastro.2010.10.049.

    Article  Google Scholar 

  5. Salem R, Gordon AC, Mouli S, et al. Y90 radioembolization significantly prolongs time to progression compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology. 2016;151:1155–63. https://doi.org/10.1053/j.gastro.2016.08.029.

    Article  PubMed  Google Scholar 

  6. Yu SCH, Hui JW, Hui EP, et al. Embolization efficacy and treatment effectiveness of transarterial therapy for unresectable hepatocellular carcinoma: a case-controlled comparison of transarterial ethanol ablation with lipiodol-ethanol mixture versus transcatheter arterial chemoembolization. J Vasc Interv Radiol. 2009;20:352–9. https://doi.org/10.1016/j.jvir.2008.12.407.

    Article  PubMed  Google Scholar 

  7. Yu SC, Hui JW, Hui EP, et al. Unresectable hepatocellular carcinoma: randomized controlled trial of transarterial ethanol ablation versus transcatheter arterial chemoembolization. Radiology. 2014;270:607–20. https://doi.org/10.1148/radiol.13130498.

    Article  PubMed  Google Scholar 

  8. Yu SC, Hui EP, Tang P, et al. Transarterial ethanol ablation for unresectable hepatocellular carcinoma: analysis of clinical and tumor outcomes. J Vasc Interv Radiol. 2016;27:639–49. https://doi.org/10.1016/j.jvir.2015.11.032.

    Article  PubMed  Google Scholar 

  9. Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015;33:550–8. https://doi.org/10.1200/JCO.2014.57.9151.

    Article  PubMed  Google Scholar 

  10. Forner A, Ayuso C, Varela M, et al. Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma: are response evaluation criteria in solid tumors reliable? Cancer. 2009;115:616–23. https://doi.org/10.1002/cncr.24050.

    Article  PubMed  Google Scholar 

  11. Riaz A, Memon K, Miller FH, et al. Role of the EASL, RECIST, and WHO response guidelines alone or in combination for hepatocellular carcinoma: radiologic-pathologic correlation. J Hepatol. 2011;54:695–704. https://doi.org/10.1016/j.jhep.2010.10.004.

    Article  PubMed  Google Scholar 

  12. Salem R, Lewandowski RJ, Gates VL, et al. Research reporting standards for radioembolization of hepatic malignancies. J Vasc Interv Radiol. 2011;22:265–78. https://doi.org/10.1016/j.jvir.2010.10.029.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol. 2017;40:1141–6. https://doi.org/10.1007/s00270-017-1703-4.

    Article  CAS  PubMed  Google Scholar 

  14. Robert J, Lewandowski RJ, Sato KT, et al. Radioembolization with 90Y microspheres: angiographic and technical considerations. Cardiovasc Intervent Radiol. 2007;30:571–92. https://doi.org/10.1007/s00270-007-9064-z.

    Article  Google Scholar 

  15. Bilbao JI, Garrastachu P, Herraiz MJ, et al. Safety and efficacy assessment of flow redistribution by occlusion of intrahepatic vessels prior to radioembolization in the treatment of liver tumors. Cardiovasc Intervent Radiol. 2009;33:523–31. https://doi.org/10.1007/s00270-009-9717-1.

    Article  PubMed  Google Scholar 

  16. Leung TW, Lau WY, Ho SK, et al. Radiation pneumonitis after selective internal radiation treatment with intraarterial 90yttriummicrospheres for inoperable hepatic tumors. Int J Radiat Oncol Biol Phys. 1995;33:919–24. https://doi.org/10.1016/0360-3016(95)00039-3.

    Article  CAS  PubMed  Google Scholar 

  17. Ho S, Lau WY, Leung TW, et al. Tumour-to-normal uptake ratio of 90Y microspheres in hepatic cancer assessed with 99Tcm macroaggregated albumin. Br J Radiol. 1997;70:823–8. https://doi.org/10.1259/bjr.70.836.9486047.

    Article  CAS  PubMed  Google Scholar 

  18. Ho S, Lau WY, Leung TW, et al. Partition model for estimating radiation doses from yttrium-90 microspheres in treating hepatic tumours. Eur J Nucl Med. 1996;23:947–52. https://doi.org/10.1007/BF01084369.

    Article  CAS  PubMed  Google Scholar 

  19. Huang YH, Wu JC, Chen SC, et al. Survival benefit of transcatheter arterial chemoembolization in patients with hepatocellular carcinoma larger than 10 cm in diameter. Aliment Pharmacol Ther. 2005;23:129–35. https://doi.org/10.1111/j.1365-2036.2006.02704.x.

    Article  Google Scholar 

  20. Xue T, Le F, Chen R, et al. Transarterial chemoembolization for huge hepatocellular carcinoma with diameter over ten centimeters: a large cohort study. Med Oncol. 2015;32:64. https://doi.org/10.1007/s12032-015-0504-3.

    Article  PubMed  Google Scholar 

  21. Chen JH, Wei CK, Lee CH, Chang CM, Yin WY. Better long-term prognosis: comparison between surgery and TACE as initial treatment for operable huge HCCs (≥10 cm) after more than 5 years of follow up. Int Surg. 2017;102:244–9. https://doi.org/10.9738/INTSURG-D-14-00316.1.

    Article  Google Scholar 

  22. Miyayama S, Kikuchi Y, Yoshida M, et al. Outcomes of conventional transarterial chemoembolization for hepatocellular carcinoma ≥ 10 cm. Hepatol Res. 2019;49:787–98. https://doi.org/10.1111/hepr.13335.

    Article  CAS  PubMed  Google Scholar 

  23. Basile A, Carrafiello G, Ierardi AM, Tsetis D, Brountzos E. Quality-improvement guidelines for hepatic transarterial chemoembolization. Cardiovasc Intervent Radiol. 2012;35:765–74. https://doi.org/10.1007/s00270-012-0423-z.

    Article  PubMed  Google Scholar 

  24. Chung JW, Park JH, Im JG, Han JK, Han MC. Pulmonary oil embolism after transcatheter oily chemoembolization of hepatocellular carcinoma. Radiology. 1993;187:689–93. https://doi.org/10.1148/radiology.187.3.8388567.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Miss Tiffany Lau and Mr. Kwok-Tung Lee for their help in this study.

Funding

This study was funded by Vascular and Interventional Radiology Foundation. The funding body had not involved in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Author information

Authors and Affiliations

  1. Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR

    Simon Chun Ho Yu, Joyce Wai-Yi Hui & Carmen Chi-Min Cho

  2. Vascular and Interventional Radiology Foundation Clinical Science Center, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR

    Simon Chun Ho Yu, Joyce Wai-Yi Hui & Carmen Chi-Min Cho

  3. Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR

    Leung Li, Edwin Pun Hui, Stephen Lam Chan & Winnie Ming-Ming Yeo

Authors
  1. Simon Chun Ho Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joyce Wai-Yi Hui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leung Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carmen Chi-Min Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Edwin Pun Hui
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephen Lam Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Winnie Ming-Ming Yeo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simon Chun Ho Yu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study formal consent is not required. This study was approved by Institutional Review Board.

Informed Consent

This study has obtained IRB approval from (indicate the relevant board) and the need for informed consent was waived.

Consent for Publication

For this type of study consent for publication is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yu, S.C.H., Hui, J.WY., Li, L. et al. Comparison of Chemoembolization, Radioembolization, and Transarterial Ethanol Ablation for Huge Hepatocellular Carcinoma (≥ 10 cm) in Tumour Response and Long-Term Survival Outcome. Cardiovasc Intervent Radiol 45, 172–181 (2022). https://doi.org/10.1007/s00270-021-02777-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-021-02777-6

Keywords

Search

Navigation