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. 2023 Jan 15:10:81-90.
doi: 10.2147/JHC.S398434. eCollection 2023.

Efficacy and Safety of Combined Ethanol-Lipiodol Mixture and Drug-Eluting Bead TACE for Large HCC

Yi-Hsuan Chuang #  1 , Yu-Fan Cheng #  1 , Leo Leung-Chit Tsang  1 , Hsin-You Ou  1 , Hsien-Wen Hsu  1 , Wei-Xiong Lim  1 , Po-Hsun Huang  1 , Ching-Chun Weng  1 , Chun-Yen Yu  1
Affiliations

Efficacy and Safety of Combined Ethanol-Lipiodol Mixture and Drug-Eluting Bead TACE for Large HCC

Yi-Hsuan Chuang et al. J Hepatocell Carcinoma. .

Abstract

Purpose: To evaluate treatment response, survival and safety of a novel TACE using combination of ethanol-Lipiodol mixture and drug-eluting beads in patients with large unresectable HCC, single tumor >8 cm or multiple tumors with the largest tumor diameter >5 cm and total tumor diameter >10 cm.

Patients and methods: Between June 2016 and February 2020, a total of 27 patients were enrolled in this retrospective cohort study. Treatment response was assessed at first month after the treatment; progression-free survival (PFS) and overall survival (OS) were evaluated. The prognostic factors associated with patient survival were statistically analyzed by the Cox regression model. Adverse events were recorded.

Results: The maximum diameter of the tumors ranged from 5 cm to 17 cm (mean 10.48 cm). The objective response and disease control rates were 56% and 78%, respectively, at 1-month follow-up. The median survival time was 15.9 months (95% CI, 9.03-34.76 months). The OS rates were 76.9% at six months, 65.2% at one year and 44.8% at two years. AFP >400 ng/mL (p = 0.0306), maximum tumor size >10cm (p = 0.0240) were potential risk factors for OS. Regarding safety, major complications occurred in one patient (1/27, 3.7%), presenting with transient hepatic encephalopathy.

Conclusion: Combined DEB-TACE appeared to have favorable objective tumor response. It can be an effective treatment option for large unresectable HCC.

Keywords: hepatocellular carcinoma; prognosis; transarterial chemoembolization; treatment response.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A) 64-year-old male with two HCCs in S4 and S8 receiving combined ethanol-Lipiodol mixture and DEB-TACE. (A and B) The hepatic angiography before and after TACE procedure showed remarkable tumor reduction. (C and D) Follow up CT at 1 month showed dense Lipiodol deposition and complete response of the tumors. After successful downstaging, the patient underwent liver transplantation. The explant confirmed complete pathologic necrosis.
Figure 2
Figure 2
A 63-year-old male receiving combined ethanol-Lipiodol mixture and DEB-TACE. (A) The initial CT image on arterial phase showed a large enhancing tumor measuring 11.15 cm in right lobe. (B) Common hepatic arteriography showed hypervascular tumor staining. (C) Angiogram after selective embolization of the tumor-feeding arteries showed complete devascularization of the tumor. (D) Follow up CT at 1 month showed Lipiodol deposition within the tumor.
Figure 3
Figure 3
Change in viable target lesion size after combined DEB-TACE.
Figure 4
Figure 4
Kaplan–Meier curves of (A) OS and (B) PFS in patients with unresectable HCC following combined DEB-TACE.
See this image and copyright information in PMC

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