Bland embolization versus chemoembolization of hepatocellular carcinoma before transplantation

Abstract

There is conflicting literature regarding the superiority of transarterial chemoembolization (TACE) versus bland transarterial embolization (TAE), and this has not been well studied before transplantation. Twenty-five TAE patients were matched in a 1:2 ratio with TACE patients by the initial radiographic tumor size and number in a retrospective, case-controlled study. The patients were otherwise treated according to the same protocols. The method of embolization was chosen on the basis of interventionalist practices at 2 sites within the program. Kaplan-Meier survival analyses at 1 and 3 years were the primary endpoints. There were no significant demographic differences between the groups. The mean adjusted Model for End-Stage Liver Disease scores at transplantation and waiting times were not significantly different between the TAE and TACE patients (MELD scores: 26 ± 3 versus 24 ± 3 points, P = 0.12; waiting times: 13 ± 8 versus 11 ± 10 months, P = 0.43). TAE patients (16%) were less likely than TACE patients (40%) to require 2 procedures (P = 0.04). Explant tumors were completely necrotic for 36% of the TAE patients and for 26% of the TACE patients. The 3-year overall survival rates were 78% for the TAE patients and 74% for the TACE patients (P = 0.66), and the 3-year recurrence-free survival rates were 72% for the TAE patients and 68% for the TACE patients (P = 0.67). On an intention-to-treat basis, there was no significant risk of wait-list dropout associated with TAE or TACE (P = 0.83). In conclusion, there were no significant differences in wait-list dropout or in overall or recurrence-free survival between HCC patients undergoing TAE and HCC patients undergoing TACE before transplantation.

Therapies for patients with hepatocellular carcinoma awaiting liver transplantation: A systematic review and meta‐analysis

“…Thirty‐one noncomparative studies enrolled HCC patients within Milan criteria and reported outcomes for transplant with any bridging therapies. Risk of bias of the noncomparative studies (Fig.…”

“…Fifteen studies reported dropout rates due to all causes, and nine studies reported dropout rates due to progression. Dropout rates due to all causes and due to progression were 0.19 (95% CI, 0.15‐0.24) and 0.11 (95% CI, 0.07‐0.17), respectively.…”

Radiofrequency vs Microwave Ablation After Neoadjuvant Transarterial Bland and Drug-Eluting Microsphere Chembolization for the Treatment of Hepatocellular Carcinoma

“…Due to patient’s accessibility to the tertiary care center and differences in outside ordering provider preferences initial imaging was conducted at 1 month (17), 2 months (9), or 3 months (9). Median time to initial post procedure imaging was 1.8 months.…”

“…Randomized controlled data has suggested reduced toxicity and with DEB-TACE compared with conventional TACE in Child Pugh B patients with advanced or recurrent disease (16). Transarterial bland embolization (TAE) is not currently recommended (5) despite large scale retrospective data that suggests comparable efficacy to TACE (17, 18). Furthermore, a recent single blind randomized controlled trial by Brown et al further demonstrated equality between TAE and TACE with regard to RECEIST response, adverse events, and overall survival in HCC patients (19).…”

Transarterial options for locoregional control in hepatoblastoma

“…Due to the paucity of medical literature describing transarterial therapies in pediatric liver tumors, adult HCC outcome and survival data are extrapolated to allow for comparison between the various techniques. Interestingly, there are data to suggest that bland embolization and TACE are equally efficacious with regard to overall, recurrence‐free survival in adults with HCC 10 . The direct effects of adding chemotherapy agents to subselective embolization remains difficult, unfortunately, because of inconsistent techniques reported throughout the literature 3 …”