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

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

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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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Correspondence to 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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Keywords

  • Interventional oncology
  • Chemoembolization/chemoembolisation
  • Liver/hepatic
  • Cancer
  • Hepatocellular carcinoma
  • DEB-TACE