Advanced-stage hepatocellular carcinoma with portal vein thrombosis: conventional versus drug-eluting beads transcatheter arterial chemoembolization
Our study sought to compare the overall survival in patients with hepatocellular carcinoma (HCC) and portal venous thrombosis (PVT), treated with either conventional trans-arterial chemoembolization (cTACE) or drug-eluting beads (DEB) TACE.
This retrospective analysis included a total of 133 patients, treated without cross-over and compared head-to-head by means or propensity score weighting. Mortality was compared using survival analysis upon propensity score weighting. Adverse events and liver toxicity grade ≥3 were recorded and reported for each TACE. In order to compare with historical sorafenib studies, a sub-group analysis was performed and included patients who fulfilled the SHARP inclusion criteria.
The median overall survival (MOS) of the entire cohort was 4.53 months (95 % CI, 3.63–6.03). MOS was similar across treatment arms, no significant difference between cTACE (N = 95) and DEB-TACE (N = 38) was observed (MOS of 5.0 vs. 3.33 months, respectively; p = 0.157). The most common adverse events after cTACE and DEB- TACE, respectively, were as follows: post-embolization syndrome [N = 57 (30.0 %) and N = 38 (61.3 %)], diarrhea [N = 3 (1.6 %) and N = 3 (4.8 %)], and encephalopathy [N = 11 (5.8 %) and N = 2 (3.2 %)].
Our retrospective study could not reveal a difference in toxicity and efficiency between cTACE and DEB-TACE for treatment of advanced stage HCC with PVT.
• Conventional TACE (cTACE) and drug-eluting-beads TACE (DEB-TACE) demonstrated equal safety profiles.
• Survival rates after TACE are similar to patients treated with sorafenib.
• Child-Pugh class and tumor burden are reliable predictors of survival.
KeywordsLiver Hepatocellular carcinoma Chemoembolization Adverse effects Propensity score
Barcelona Clinic Liver Cancer
Conventional trans-arterial chemoembolization
National Cancer Institute Common Terminology Criteria for Adverse Events
Drug-eluting beads TACE
European Association for the Study of the Liver
- ECOG PS
Eastern Cooperative Oncology Group performance status
Hong Kong Liver Cancer
Median overall survival
Magnet resonance imaging
Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol
- Y90 RE
Yttrium 90 radioembolization
The scientific guarantor of this publication is Jean-Francois Geschwind MD. The authors of this manuscript declare relationships with the following companies. Jean-Francois Geschwind: Philips Medical, Nordion, Biocompatibles/BTG, Bayer HealthCare, DOB, Context Vision, SIR, RSNA; Guerbet
MingDe Lin: Philips Research North America employee.
Boris Gorodetski, Julius Chapiro, Ruediger Schernthaner, Rafael Duran, Howard Lee, David Lenis, Elizabeth A. Stuart, Bareng Aletta Sanny Nonyane, Vasily Pekurovsky, Anobel Tamrazi, and Timothy M. Pawlik: no relevant relationship to a company.
This study was funded by NIH/NCI R01 CA160771, P30 CA006973, NCRR UL1 RR 025005, Philips Research North America, Briarcliff Manor, New York, Ernst Ludwig Ehrlich Foundation, Gerhard C. Starck Foundation and the Rolf W. Günther Foundation for Radiological Science. There are no financial or other conflicts of interest in relation to this manuscript. David Lenis, Elizabeth A. Stuart PhD and Bareng Aletta Sanny Nonyane PhD kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Some study subjects or cohorts have been previously presented at the RSNA conference 2014 and at the CIRSE conference in Lisbon 2015.
Gorodetski, et al. Survival outcomes in patients with advanced-stage HCC and portal vein thrombosis: Comparison between conventional and drug-eluting beads TACE. The abstract was presented at the 100th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Chicago, Illinois, 30 November – 5 December 2014.
Gorodetski, et al. Is trans-arterial chemoembolization safe in patients with advanced to end-stage HCC and portal vein invasion? Comparison between conventional and drug-eluting beads TACE. The abstract was presented at the last CIRSE meeting. Lisbon, Portugal, 26 – 30 September 2015.
Methodology: retrospective, observational, performed at one institution.
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