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. 2012 Jun;56(6):1330-5.
doi: 10.1016/j.jhep.2012.01.008. Epub 2012 Feb 5.

Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using Drug Eluting Beads. Implications for clinical practice and trial design

Marta Burrel  1 , María Reig, Alejandro Forner, Marta Barrufet, Carlos Rodríguez de Lope, Silvia Tremosini, Carmen Ayuso, Josep M Llovet, María Isabel Real, Jordi Bruix
Affiliations

Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using Drug Eluting Beads. Implications for clinical practice and trial design

Marta Burrel et al. J Hepatol. 2012 Jun.

Abstract

Background & aims: Transarterial chemoembolisation (TACE) improves survival of properly selected patients with hepatocellular carcinoma (HCC). Drug eluting beads (DEB) provide a calibrated and homogenous procedure while increasing efficacy. Outcome data applying this technology is lacking, and this is instrumental for clinical decision-making and for trial design. We evaluated the survival of HCC patients treated with DEB-TACE following a strict selection (preserved liver function, absence of symptoms, extrahepatic spread or vascular invasion).

Methods: We registered baseline characteristics, the development of treatment-related adverse events, and the overall survival of all HCC patients treated by DEB-TACE from February 2004 to June 2010.

Results: One hundred and four patients were treated with DEB-TACE. All but one were cirrhotic, 62.5% HCV+, 95% Child-Pugh A, 41 BCLC-A and 63 BCLC-B. Causes of DEB-TACE treatment in BCLC-A patients were: 35 unfeasible ablation, and six post-treatment recurrences. After a median follow-up of 24.5 months, 38 patients had died, two patients had received transplantation and 24 had received sorafenib because of untreatable tumour progression. Median survival of the cohort was 48.6 months (95% CI: 36.9-61.2), while it was 54.2 months in BCLC stage A and 47.7 months in stage B. Median survival after censoring follow-up at time of transplant/sorafenib was 47.7 (95%CI: 37.9-57.5) months.

Conclusions: These data validate the safety of DEB-TACE and show that the survival expectancy applying current selection criteria and technique is better than that previously reported. A 50% survival at 4 years should be considered when suggesting treatment for patients fitting into controversial scenarios such as expanded criteria for transplantation/resection for multifocal HCC.

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Conflict of interest statement

Conflict of interest

J. Bruix had exerted as consultant or received grants from: Sumitomo, Pharmexa, Eisai, Biocompatibles, Biolliance, Bayer Schering, Lilly, Novartis, Arqule, Angiodynamics, Kowa, Imclone.

C. Ayuso, M. Burrel, A. Forner, M. Reig, and C. Rodriguez-Lope had exerted as consultant: Terumo Europe, Bayer Schering.

M. Barrufet and M. Real had exerted as consultant: Terumo Europe.

M. Llovet received Research Support from: Bayer Pharmaceutical, Bristol Myers Squibb and Consultancy Agreements from Bayer Pharmaceutical, Bristol Myers Squibb, Imclone, Biocompatibles.

Figures

Fig. 1.
Fig. 1.
Overall survival in the whole cohort.
Fig. 2.
Fig. 2.
Overall survival in patients within BCLC-A.
Fig. 3.
Fig. 3.
Overall survival in patients within BCLC-B.
Fig. 4.
Fig. 4.
Overall survival in the whole cohort after censoring patients with liver transplantation and sorafenib treatment.
See this image and copyright information in PMC

Comment in

References

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