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.
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.
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.
DEB-TACE is safe and effective in patients with advanced HCC. ECOG PS ≤ 1 and >2 DEB-TACE procedures were associated with better OS.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108
Marrero JA (2003) Hepatocellular carcinoma. Curr Opin Gastroenterol 19:243–249
Forner A, Reig ME, de Lope CR, Bruix J (2010) Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis 30:61–74
Llovet JM (2005) Updated treatment approach to hepatocellular carcinoma. J Gastroenterol 40:225–235
Bruix J, Sherman M (2005) Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 42:1208–1236
Bruix J, Sherman M (2011) American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022
Lammer J, Malagari K, Vogl T et al (2010) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33:41–52
Llovet JM, Ricci S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–390
Faivre S, Raymond E, Boucher E et al (2009) Safety and efficacy of sunitinib in patients with advanced hepatocellular carcinoma: an open-label, multicentre, phase II study. Lancet Oncol 10:794–800
Llovet JM, Real MI, Montaña X et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359:1734–1739
Lo CM, Ngan H, Tso WK et al (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35:1164–1171
Cammà C, Schepis F, Orlando A et al (2002) Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology 224:47–54
Sakamoto I, Aso N, Nagaoki K et al (1998) Complications associated with transcatheter arterial embolization for hepatic tumors. Radiographics 18:605–619
Chung JW, Park JH, Han JK et al (1996) Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology 198:33–40
Solomon B, Soulen MC, Baum RA et al (1999) Chemoembolization of hepatocellular carcinoma with cisplatin, doxorubicin, mitomycin-C, Ethiodol, and polyvinyl alcohol: prospective evaluation of response and survival in a US population. J Vasc Interv Radiol 10:793–798
Malagari K, Pomoni M, Spyridopoulos TN et al (2011) Safety profile of sequential transcatheter chemoembolization with DC Bead™: results of 237 hepatocellular carcinoma (HCC) patients. Cardiovasc Intervent Radiol 34:774–785
Malagari K, Alexopoulou E, Chatzimichail K et al (2008) Transcatheter chemoembolization in the treatment of HCC in patients not eligible for curative treatments: midterm results of doxorubicin-loaded DC bead. Abdom Imaging 33:512–519
Pomoni M, Malagari K, Moschouris H et al (2012) Postembolization syndrome in doxorubicin eluting chemoembolization with DC Bead. Hepatogastroenterology 59:820–825
Vogl TJ, Lammer J, Lencioni R et al (2011) Liver, gastrointestinal, and cardiac toxicity in intermediate hepatocellular carcinoma treated with PRECISION TACE with drug-eluting beads: results from the PRECISION V randomized trial. Am J Roentgenol 197:W562–W570
Carr BI, Bron K, Swanson DP (2011) Prospective randomized trial of hepatic artery chemotherapy with cisplatin and doxorubicin, with or without lipiodol in the treatment of advanced stage hepatocellular carcinoma. J Clin Gastroenterol 45:e87–e91
Watanabe S, Nishioka M, Ohta Y, Ogawa N, Ito S, Yamamoto Y (1994) Prospective and randomized controlled study of chemoembolization therapy in patients with advanced hepatocellular carcinoma. Cooperative Study Group for Liver Cancer Treatment in Shikoku area. Cancer Chemother Pharmacol 33(Suppl):S93–S96
Lopez PM, Villanueva A, Llovet JM (2006) Systematic review: evidence-based management of hepatocellular carcinoma—an updated analysis of randomized controlled trials. Aliment Pharmacol Ther 23:1535–1547
Trinchet JC, Ganne-Carrie N, Beaugrand M (2003) Review article: intra-arterial treatments in patients with hepatocellular carcinoma. Aliment Pharmacol Ther 17(Suppl 2):111–118
Common terminology criteria for adverse events v3.0 (CTCAE). http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm. Accessed 7 Apr 2012
Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247
Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216
Varela M, Sala M, Llovet JM, Bruix J (2003) Treatment of hepatocellular carcinoma: is there an optimal strategy? Cancer Treat Rev 29:99–104
Venook AP (1994) Treatment of hepatocellular carcinoma: too many options? J Clin Oncol 12:1323–1334
Maggs JR, Suddle AR, Aluvihare V, Heneghan MA (2012) Systematic review: the role of liver transplantation in the management of hepatocellular carcinoma. Aliment Pharmacol Ther 35:1113–11134
Cormier JN, Thomas KT, Chari RS, Pinson CW (2006) Management of hepatocellular carcinoma. J Gastrointest Surg 10:761–780
Choi JY (2011) Treatment algorithm for intermediate and advanced stage hepatocellular carcinoma: Korea. Oncology 81(Suppl 1):141–147
Lencioni R, Chen XP, Dagher L, Venook AP (2010) Treatment of intermediate/advanced hepatocellular carcinoma in the clinic: how can outcomes be improved? Oncologist 15(Suppl 4):42–52
Oliveri RS, Wetterslev J, Gluud C (2011) Transarterial (chemo)embolisation for unresectable hepatocellular carcinoma. Cochrane Database Syst Rev 3:CD004787
Leung DA, Goin JE, Sickles C, Raskay BJ, Soulen MC (2001) Determinants of postembolization syndrome after hepatic chemoembolization. J Vasc Interv Radiol 12:321–326
Marelli L, Stigliano R, Triantos C et al (2007) Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol 30:6–25
van Malenstein H, Maleux G, Vandecaveye V et al (2011) A randomized phase II study of drug-eluting beads versus transarterial chemoembolization for unresectable hepatocellular carcinoma. Onkologie 34:368–376
Dhanasekaran R, Kooby DA, Staley CA, Kauh JS, Khanna V, Kim HS (2010) Comparison of conventional transarterial chemoembolization (TACE) and chemoembolization with doxorubicin drug eluting beads (DEB) for unresectable hepatocellular carcinoma (HCC). J Surg Oncol 101:476–480
Nicolini A, Martinetti L, Crespi S, Maggioni M, Sangiovanni A (2010) Transarterial chemoembolization with epirubicin-eluting beads versus transarterial embolization before liver transplantation for hepatocellular carcinoma. J Vasc Interv Radiol 21:327–332
Llovet JM (2002) Evidence-based medicine in the treatment of hepatocellular carcinoma. J Gastroenterol Hepatol 17(Suppl 3):S428–S433
Pawlik TM, Reyes DK, Cosgrove D, Kamel IR, Bhagat N, Geschwind JF (2011) Phase II trial of Sorafenib combined with concurrent transarterial chemoembolization with drug eluting beads for hepatocellular carcinoma. J Clin Oncol 29:3960–3967
Iavarone M, Cabibbo G, Piscaglia F, Zavaglia C, Grieco A, Villa E, Camma C, Colombo M (2011) Field-practice study of sorafenib therapy for hepatocellular carcinoma: a prospective multicenter study in Italy. Hepatology 54:2055–2063
Pinter M, Hucke F, Graziadei I, Vogel W, Maieron A, Konigberg R, Stauber R, Grunberger B, Muller C, Kolblinger C, Peck-Radosavljevic M, Sieghart W (2012) Advanced-stage hepatocellular carcinoma: transarterial chemoembolization versus sorafenib. Radiology 263:590–599
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.
About this article
Cite this article
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
- Interventional oncology
- Hepatocellular carcinoma