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Liver and biliary damages following transarterial chemoembolization of hepatocellular carcinoma: comparison between drug-eluting beads and lipiodol emulsion

European Radiology volume 27, pages 1431–1439 (2017)Cite this article

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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Affiliations

  1. Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland

    Arnaud Monier, Boris Guiu, Rafael Duran, Pierre Bize, Vincent Dunet & Alban Denys

  2. Department of Diagnostic and Interventional Radiology, Montpellier University Hospital, Montpellier, 34000, Avenue Emile Bertin Sans, France

    Boris Guiu

  3. Department of Epidemiology, University Hospital, Dijon, 21000, boulevard Jeanne d’Arc, France

    Serge Aho

  4. Department of Gastroenterology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland

    Pierre Deltenre

Authors
  1. Arnaud Monier
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  2. Boris Guiu
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  3. Rafael Duran
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  4. Serge Aho
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  5. Pierre Bize
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  7. Vincent Dunet
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  8. Alban Denys
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Correspondence to Alban Denys.

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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

Keywords

  • Hepatocellular carcinoma
  • Chemoembolization
  • TACE
  • Magnetic resonance imaging
  • Toxicity