Abstract
Objectives
To compare transarterial chemoembolization (TACE)-related hepatic toxicities of conventional TACE (cTACE) and drug-eluting beads TACE (DEB-TACE) in patients with intermediate-stage hepatocellular carcinoma.
Methods
In this retrospective study, 151 consecutive patients undergoing cTACE or DEB-TACE and MRI 3-6 weeks before and after therapy were included. Toxicity was assessed on imaging (global hepatic damages (GHD), overall biliary injuries, biliary cast, bile duct dilatation, intrahepatic biloma, portal thrombosis), and clinico-biological follow-ups. Tumour response, time to progression (TTP), and overall survival were assessed. Factors influencing complication rate were identified by generalized equation logistic regression model.
Results
Biliary injuries and intrahepatic biloma incidence were significantly higher following DEB-TACE (p < 0.001). DEB-TACE showed a significant increased risk of GHD (OR: 3.13 [1.74-5.63], p < 0.001) and biliary injuries (OR: 4.53 [2.37-8.67], p < 0.001). A significant relationship was found between baseline prothrombin value and GHD, biliary injuries and intrahepatic biloma (all p < 0.01), and between the dose of chemotherapy and intrahepatic biloma (p = 0.001). Only TTP was significantly shorter following DEB-TACE compared to cTACE (p = 0.025).
Conclusions
DEB-TACE was associated with increased hepatic toxicities compared to cTACE. GHD, biliary injuries, and intrahepatic biloma were more frequently observed with high baseline prothrombin value, suggesting that cTACE might be more appropriate than DEB-TACE in patients with less advanced cirrhosis.
Key points
• DEB-TACE demonstrated more therapy-related hepatic locoregional complications compared to cTACE.
• TACE-related hepatic locoregional toxicities occurred more frequently with high baseline PT value.
• cTACE may be more appropriate in patients with high baseline PT value.
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Abbreviations
- AFP:
-
Alpha-fetoprotein
- ALT:
-
Alanine aminotransferase
- AST:
-
Aspartate aminotransferase
- cTACE:
-
Conventional transarterial chemoembolization
- DEB-TACE:
-
Drug-eluting beads transarterial chemoembolization
- GHD:
-
Global hepatic damages
- HCC:
-
Hepatocellular carcinoma
- PT:
-
Prothrombin time
- PVT:
-
Portal vein thrombosis
- OS:
-
Overall survival
- TR:
-
Tumour response
- TTP:
-
Time to progression
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Acknowledgments
The scientific guarantor of this publication is Alban Denys. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.
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Monier, A., Guiu, B., Duran, R. et al. Liver and biliary damages following transarterial chemoembolization of hepatocellular carcinoma: comparison between drug-eluting beads and lipiodol emulsion. Eur Radiol 27, 1431–1439 (2017). https://doi.org/10.1007/s00330-016-4488-y
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DOI: https://doi.org/10.1007/s00330-016-4488-y