Balloon-Occluded Transcatheter Arterial Chemoembolization (b-TACE) for Hepatocellular Carcinoma Performed with Polyethylene-Glycol Epirubicin-Loaded Drug-Eluting Embolics: Safety and Preliminary Results

Abstract

Purpose To report technical success, safety profile and oncological results of balloon-occluded transcatheter arterial chemoembolization using a balloon micro-catheter and epirubicin-loaded polyethylene-glycol (PEG) microsphere (100 ± 25 µm and 200 ± 50 µm) in patients with hepatocellular carcinoma (HCC). Materials and Methods This is a single-centre, single-arm, retrospective study with 6-month follow-up. Twenty-two patients (Child–Pugh A 68% [15/22], B in 32% [7/22]; age 67.05 ± 14 years) with 29 HCC were treated in 24 procedures. Technical success is defined: ability to place the balloon micro-catheter within the required vascular segment, balloon-occluded arterial stump pressure drops and assessment of microsphere deposition. Laboratory assessment pre/post-procedural and complications were analysed, respectively, according to Common Terminology Criteria for Adverse Events (CTCAEv5) and CIRSE system. Postembolization syndrome (PES) was defined as fever and/or nausea and/or pain onset. Oncological results were evaluated using m-RECIST criteria with CT/MRI imaging at 1 and 3–6 months. In partial responder patients, pre/post-procedural tumour volume was compared. Results Pre-planned feeder was reached in all cases. Pressure drop average was 51.1 ± 21.6 mmHg. Exclusive target embolization was achieved in 14/24 procedures (58.3%). Laboratory test modifications were all grade 1. 4/24 adverse events occurred (17%): pseudo-aneurysm of the feeder (grade 3), liver abscess (grade 2) and 2 asymptomatic segmentary biliary tree dilatations (grade 2). PES occurred in 8/24 (33%). The complete response at 1 and 3–6 months was 44.8% (13/29) and 52.9% (9/17), respectively. The partial response at 1 and 3–6 months was 55% (16/29) and 4/17 (23.5%), respectively. Among partial responder patients, the average percentage of tumour volume reduction was 64.9 ± 27.3%. Conclusion Epirubicin-loaded PEG microsphere b-TACE is technically feasible, safe and effective procedure for HCC treatment.

Drug-eluting beads transarterial chemoembolization with CalliSpheres microspheres for treatment of unresectable intrahepatic cholangiocarcinoma

“…The treatment response including complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) was assessed according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) [9]. All adverse events(AEs) were recorded and evaluated using the five grade Common Therapy Evaluation Program's Common Terminology Criteria for Adverse Events(CTCAE version 5.0) [10]. For patients with multiple diseases, the two largest focus was selected for response assessment.…”

Transcatheter arterial embolization for unruptured renal angiomyolipoma using a 1.8-Fr tip microballoon catheter with a mixture of ethanol and Lipiodol

“…The evolution of microballoons have enabled various procedures such as balloon-occluded transarterial chemoembolization for hepatocellular carcinoma (Lucatelli et al, 2019;Matsumoto et al, 2015;Matsumoto et al, 2016;Matsumoto et al, 2017), balloon-occluded retrograde transvenous obliteration for gastric varices (Mine et al, 2017), and coaxial microballoon-occluded coil embolization for vascular disorders (Yasumoto et al, 2015). The present study shows, for the first time, the effectiveness and safety of TAE using a 1.8-Fr tip microballoon catheter with a mixture of ethanol and Lipiodol in the treatment of unruptured renal AML.…”

Balloon Occluded TACE (B-TACE) vs DEM-TACE for HCC. A Single Center Retrospective Case Control Study.

“…No differences were observed between B-TACE and DEM-TACE in terms of AEs. Of note, the grade 3 AEs (pseudoaneurysm) observed in the B-TACE subgroup occurred during the learning curve of balloon micro-catheter usage (within the rst ve cases) 8,18 . It is to be noted that also during DEM-TACE procedures grade 3 hepatic artery injury (de ned as occlusions) occurred [8/205 (3.9%) after 2 sessions of TACE] as reported by Suh et al 19 .…”

“…The secondary outcome was to compare differences in terms of safety pro le between the two techniques including modi cations of post-procedural liver function test, occurrence of post-embolic syndrome (PES) and adverse event. PES was de ned as fever and/or nausea and/or pain presenting up to 48 h after the procedures 8 . Adverse events (AEs) were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAEv5) 14 .…”

“…The literature regarding the use of this balloon micro-catheter in combination with Drug Eluting microsphere (DEM-TACE) is scarce. To our knowledge, only two studies reported the use of DEM-TACE with a balloon micro-catheter 7,8 with an objective response of 90% and 100%, respectively. There is currently no evidence on which patients should be offered b-TACE, particularly when the procedure is performed with DEM.…”