Balloon occluded TACE (B-TACE) vs DEM-TACE for HCC: a single center retrospective case control study

Abstract

Background To compare oncological results and safety profile of balloon micro-catheter trans-arterial chemoembolization (b-TACE) and drug-eluting-microsphere (DEM-TACE) in patients with hepatocellular-carcinoma (HCC). Methods This is a case–control, retrospective, single-center study. Between January-2015/March-2019, 149 patients (131 males [87.9%]) with 226 HCC were treated, 22 patients (35 HCC; 19 [86.4%] males) with b-TACE and 127 with DEM-TACE (191 HCC, 112 [88.2%] males). Embolization protocol was standardized (sequential 100 ± 25 and 200 ± 25 μm microspheres). Results were evaluated by modified-response-evaluation-criteria-in-solid-tumor [mRECIST] at 1, 3–6 and 9–12 months and time to recurrence after complete response [TTR] at 1 years. Cox’s regression weighted with tumor dimensions was performed. Adverse events (AEs) were recorded. Results mRECIST oncological response at all time points (1, 3–6 and 9–12 months) for both treatments were similar, with the exception of Objective response rate at 9-12 months. Objective response at 1 and 3–6 months between b-TACE vs DEM-TACE [23/35 (65.7%) vs 119/191 (62.3%), 21/29 (72.4%) vs 78/136 (57.4%) (p > 0.05), respectively]. On the contrary, at 9–12 months, it was significantly higher in b-TACE subgroup than DEM-TACE (15/19 [78.9%] vs 48/89 [53.9%], p = 0.05). TTR for complete response at 1 year had a better trend for b-TACE vs DEM-TACE (278.0 days [196.0–342.0] vs 219.0 days [161.0–238.0], OR 0.68 [0.4–1.0], p = 0.10). The use of balloon micro-catheter reduced the relative risk of the event of recurrence by 0.63 [CI95% 0.38–1.04]; p = 0.07). No significant differences were found in AEs rate. Conclusion b-TACE showed a trend of better oncological response over DEM-TACE with and longer TTR with a similar adverse events rate, in patients presenting with larger tumors.

Durable complete response is achieved by balloon‐occluded transcatheter arterial chemoembolization for hepatocellular carcinoma

“…Lucatelli et al and Golfieri et al reported that B‐TACE achieved the best clinical performance for 3–5 cm of nodular size in treatment. [ 35 , 36 ] It is still unclear why B‐TACE is more effective in cases with a bigger tumor size. However, a report showed the relationship between an increase in microvascular invasion or microsatellite lesions and bigger tumor size.…”

Efficacy and safety of HIFU in combination with TACE in unresectable pediatric HB: A randomized, controlled, single-center clinical trial

“…[26] In contrast, HIFU has the effect of regulating immunity and inhibiting viral replication, and has better efficacy in treating HB in children, and it is easy to take and has few adverse effects, which provides a new way and method for the treatment of chronic hepatitis. [27] Although this study is novel but also has shortcomings, HIFU has been widely recognized for the treatment of HB in children, but as an emerging treatment modality, there are still many basic theories, such as ultrasound dosimetry, thermal dosimetry, noninvasive temperature monitoring, and moderate modulation of cavitation effects, that need to be studied in depth. Meanwhile, the role and status of HIFU in the treatment of HB in children also needs to be confirmed by more data from large sample, multicenter prospective clinical randomized controlled studies.…”

Transarterial Chemoembolization for Hepatocellular Carcinoma: Why, When, How?

“…The advantages of this method are the prevention of embolic agents’ leakage and the increased accumulation of Lipiodol emulsion within the tumor that may enhance treatment success due to prolonged cytotoxic effect [ 23 ]. The current literature suggests a potential advantage of B-TACE, compared to DEB-TACE, for patients with large tumors, but further studies must be conducted to reach safe conclusions [ 26 ].…”