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Safety and Efficacy of Transarterial Radioembolisation in Patients with Intermediate or Advanced Stage Hepatocellular Carcinoma Refractory to Chemoembolisation

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Abstract

Introduction

Transarterial chemoembolisation (TACE) is the most widely used locoregional treatment for patients with an unresectable hepatocellular carcinoma (HCC). Transarterial radioembolisation (TARE) with yttrium-90 containing microspheres is an emerging interventional treatment that could be complementary or an alternative to TACE.

Aim

To evaluate the safety and efficacy of TARE in patients with HCC who are refractory to TACE with drug-eluting beads (DEB-TACE).

Methods

We identified all patients who received TARE for HCC following one or more sessions of DEB-TACE in the period 2007–2016. Grade ≥3 adverse events were graded according to Common Terminology Criteria for Adverse events. Response on MRI was determined on MRI by modified RECIST. Overall survival was estimated using the Kaplan–Meier method and was determined from the first TACE and from the TARE procedure.

Results

A total of 30 patients were included. Patients had a mean of 1.7 TACE procedures (range 1–4) prior to TARE. Grade 3 adverse events following TARE included: fatigue (20%), bilirubin increase (10%), cholecystitis (3.3%) and a gastric ulcer (3.3%). Response on MRI was achieved in 36.7%. Three patients (10%) were downstaged within the Milan criteria and received liver transplantation. The median overall survival after first TACE was 32.3 months (17.2–42.1 95% CI). The median overall survival after TARE was 14.8 months (8.33–26.5 95% CI).

Conclusion

TARE is safe and can be effective in patients with an intermediate or advanced stage HCC who are refractory to TACE. This treatment strategy has the potential to downstage to liver transplantation.

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Authors and Affiliations

  1. Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium

    Elisabeth G. Klompenhouwer, Raphaëla C. Dresen, Lawrence Bonne, Vincent Vandevaveye & Geert Maleux

  2. Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Elisabeth G. Klompenhouwer

  3. Department of Digestive Oncology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium

    Chris Verslype

  4. Department of Biostatistics and Statistical Bioinformatics, KU Leuven Universiteit Hasselt, Kapucijnenvoer 35, 3000, Louvain, Belgium

    Annouschka Laenen

  5. Department of Pathology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium

    Gert De Hertogh

  6. Nuclear Medicine, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium

    Christophe M. Deroose

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Correspondence to Geert Maleux.

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Conflict of interest

GM and CMD are consultants to SIRTEX, the manufacturer of the 90Y-microspheres. The other authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Formal consent is not required for this type of study. This article does not contain any studies in animals performed by any of the authors.

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Klompenhouwer, E.G., Dresen, R.C., Verslype, C. et al. Safety and Efficacy of Transarterial Radioembolisation in Patients with Intermediate or Advanced Stage Hepatocellular Carcinoma Refractory to Chemoembolisation. Cardiovasc Intervent Radiol 40, 1882–1890 (2017). https://doi.org/10.1007/s00270-017-1739-5

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