DEB TACE for Intermediate and advanced HCC - Initial Experience in a Brazilian Cancer Center

Abstract

Background: According to Barcelona Clinic Liver Cancer classification transarterial chemoembolization is indicated in patients with Hepatocellular Carcinoma in the intermediate stage. Drug-eluting microspheres can absorb and release the chemotherapeutic agent slowly for 14 days after its intra-arterial administration. This type of transarterial chemoembolization approach appears to provide at least equivalent effectiveness with less toxicity.

Methods: This is a prospective, single-center study, which evaluated 21 patients with intermediate and advanced hepatocellular carcinoma who underwent transarterial chemoembolization with drug-eluting microspheres. The follow up period was 2 years. Inclusion criteria was Child-Pugh A or B liver disease patients, intermediate or advanced hepatocellular carcinoma and performance status equal or below 2. Transarterial chemoembolization with drug-eluting microspheres was performed at 2-month intervals during the first two sessions. The third and subsequent sessions were performed according to the image findings on follow-up, on a "demand schedule". Tumor response and time to progression were evaluated along the two-year follow up period.

Results: Of the 21 patients 90% presented with liver cirrhosis, 62% had Barcelona Clinic Liver Cancer stage B and 38% had Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma. Average tumor size was 6.9 cm. The average number of Transarterial chemoembolization with drug-eluting microspheres procedures was 3 with a total of 64 sessions. The predominant toxicity was mild. Liver function was not significantly affected in most patients. Two deaths occurred within 90 days after Transarterial chemoembolization with drug-eluting microspheres (ischemic hepatitis and hydropic decompensation). Technical success was achieved in 63 of 64 procedures. The mean hospital stay was 1.5 days. The progression free and overall survival at 1 and 2 years were 73.0% and 37.1%, 73.7% and 41.6%, respectively.

Conclusion: Transarterial chemoembolization with drug-eluting microspheres is able to deliver significant tumor response and progression free survival rate with acceptable toxicity. Larger studies are needed to identify exactly which subset of advanced hepatocellular patients may benefit from this treatment.

Trial registration: study ID ISRCTN16295622. Registered October 14th 2016. Retrospectively registered. Website registration: http://www.isrctn.com/ISRCTN16295622.

Fig. 1

Computed tomography before DEB TACE. Computed tomography showing a hypervascular liver tumor in the left lobe compatible with Hepatocellular Carcinoma in a 71 year-old female patient with liver cirrhosis and hepatitis C

Fig. 2

Angiography during DEB TACE. During the DEB TACE procedure the angiography shows the hypervascular lesion

Fig. 3

Computed tomography after DEB TACE. Computed tomography 30 days after DEB TACE showing lack of enhancement in the liver tumor consistent with complete response accordingly to the EASL criteria

Fig. 4

Magnetic Resonance before DEB TACE. A 62 year-old male with alcoholic liver cirrhosis and a large HCC in the right hepatic lobe. At magenetic resonance the lesion is hypervascular with its central portion showing some areas of no contrast enhancement suggestive of necrosis

Fig. 5

Angiography during DEB TACE. The angiography during TACE shows the large tumor occupying a central position in the liver

Fig. 6

Magnetic resonance after DEB TACE. Magnetic Resonance done four months after DEB TACE showed that the tumor is now avascular. By the EASL criteria there is a complete response but with the Recist criteria the analysis would be just of stable disease

Fig. 7

Progression-free survival. Graphic showing Kaplan-Meier estimates of progression-free survival in the 21 patients treated with DEB TACE in our study along the follow-up

Fig. 8

PFS accordingly to HCC staging. Graphic showing Kaplan-Meier estimates of progression-free survival of patients treated with DEB TACE in our study along the follow-up stratified by the HCC BCLC staging classification. Stage B HCC black line. Stage C HCC dotted red line