Transarterial embolisation of hepatocellular carcinoma with doxorubicin-eluting beads: single centre early experience

Abstract

Purpose: This is a retrospective study to evaluate the results of our early experience of using doxorubicin eluting beads (DEB) to treat patients with early and intermediate hepatocellular carcinoma (HCC).

Material and methods: A cohort of 19 patients (84.2% male; 15.8% female; mean age 59.2 years ± 11.0; range, 32-80 years) with documented HCC of size 1.8-10cm (mean, 4.0cm ± 1.8 ) undergoing DEB transarterial chembolisation (TACE) was reviewed. All patients had at least one image examination (multiphase computed tomography or magnetic resonance imaging) after embolisation.

Results: A total of 32 procedures were performed. The objective response according to the European Association for the Study of the Liver criteria was 57.9% at 1-month, 42.8% at 6-month and 50.0% at 1-year follow up. There were 4 (21.1%) treatment-related complications (1 liver abscess, 2 pancreatitis and 1 tumour rupture) which resulted in 2 deaths. One death occurred 3 weeks after second embolisation, due to ruptured pancreatic pseudocyst, giving a 5.3% 30-day mortality rate. Another patient died 2 months after embolisation caused by tumour rupture. Eight patients received radiofrequency ablation after embolisation for residual or recurrent tumours. The 1-year survival rate in the DEB TACE only group was 80% while the 1- and 2-year survival rate in the group that received radiofrequency after DEB TACE was 85.7% and 100% respectively.

Conclusion: DEB TACE is safe and effective in select group of patients. Survival may be improved when combined with other treatment modality.

Keywords: Drug-eluting beads; doxorubicin; embolisation; hepatocellular carcinoma.

Figure 1

Multiphase CT in arterial phase showing a focal enhancing lesion in segment 6 (A). Angiogram before embolisation shows tumour (arrows) supplied by the branch of right hepatic artery (B). Multiphase CT in arterial phase 1 month after embolisation reveals complete disappearance of tumour, in keeping with complete response (C).

Figure 2

Multiphase CT in arterial phase showing a heterogenously enhancing lesion in the right lobe of liver (A). 1-month follow up CT in arterial phase shows tumour necrosis of most of the tumour with a small residual nodule at the periphery, in keeping with partial response (B).