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Safety and Effectiveness of Chemoembolization with Drug-Eluting Beads for Advanced-Stage Hepatocellular Carcinoma

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Abstract

Background

According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, patients with advanced stage (BCLC-C) hepatocellular carcinoma (HCC) are recommended for systemic treatment or palliative therapy. However, chemoembolization with drug-eluting beads (DEB-TACE) has been shown to be safe in high-risk patients. The purpose of our study was to evaluate the safety and effectiveness of DEB-TACE in patients with an advanced-stage HCC.

Methods

In this institutional review board-approved, retrospective study, 80 patients with advanced-stage HCC underwent DEB-TACE with doxorubicin. Patients were evaluated for median hospital stay, incidence of Grade 3/4 toxicities, 30-day mortality, progression-free survival (PFS), and overall survival (OS) following DEB-TACE. Univariate and multivariate analysis were performed for predictors of better OS.

Results

The median hospital stay following DEB-TACE was 1 day (range: 1–11). The median PFS and OS were 5.1 months [95 % confidence interval (CI): 4.1–7.7] and 13.3 months (95 % CI: 10.1–18.6) respectively. On multivariate analysis ECOG PS ≤ 1 and >2 DEB-TACE procedures were associated with better OS. Patients with ECOG PS ≤ 1 demonstrated a median survival of 17.7 months compared with 5.6 months for patients with ECOG PS > 1 (p = 0.025). Multiple DEB-TACE procedures (>2 procedures) were associated with improved survival (26.8 months) compared with patients with one or two procedures (11.4 months, p = 0.01). Portal vein thrombosis or extrahepatic disease had no statistically significant association with OS.

Conclusions

DEB-TACE is safe and effective in patients with advanced HCC. ECOG PS ≤ 1 and >2 DEB-TACE procedures were associated with better OS.

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Acknowledgments

None.

Conflict of interest

Sanjeeva Kalva, Melina Pectasides, Raymond Liu, Niranjan Rachamreddy, Shravani Surakanti, Kalpana Yeddula, Suvranu Ganguli, Stephan Wicky, Lawrence S. Blaszkowsky, Andrew X. Zhu have no conflict of interest.

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Authors and Affiliations

  1. Center for Image Guided Cancer Therapy, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA

    Melina Pectasides, Raymond Liu, Niranjan Rachamreddy, Suvranu Ganguli & Stephan Wicky

  2. MGH Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA

    Lawrence S. Blaszkowsky & Andrew X. Zhu

  3. Department of Radiology, St. Joseph Hospital, Chicago, IL, USA

    Kalpana Yeddula

  4. Department of Internal Medicine, Baton Rouge General Hospital, Baton Rouge, LA, USA

    Shravani Surakanti

  5. Interventional Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8834, USA

    Sanjeeva P. Kalva

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  1. Sanjeeva P. Kalva
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Kalva, S.P., Pectasides, M., Liu, R. et al. Safety and Effectiveness of Chemoembolization with Drug-Eluting Beads for Advanced-Stage Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 37, 381–387 (2014). https://doi.org/10.1007/s00270-013-0654-7

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