Efficacy of combined bland embolization and chemoembolization for huge (≥10 cm) hepatocellular carcinoma

Hidaka, Teruyuki; Anai, Hiroshi; Sakaguchi, Hiroshi; Sueyoshi, Satoru; Tanaka, Toshihiro; Yamamoto, K; Morimoto, Kengo; Nomura, Hideyuki; Maeda, Shinsaku; Nagata, T.; Kichikawa, Kimihiko

doi:10.1080/13645706.2020.1725580

Cited by 13 publications

(10 citation statements)

References 21 publications

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“…Some patients with other etiologies such as HCV or alcohol use may exhibit different tumor characteristics. Finally, the use of several kinds of chemotherapeutic drugs and embolization materials when TACE is in operation may interfere with the effectiveness of treatment; e.g., bland transarterial embolization using gelatin sponge particles followed by transarterial chemoembolization using lipiodol mixed with anticancer agents and gelatin sponge particles, which improve survival in patients with HHCC [ 4 ]. Further studies are required to establish the standard regime in cTACE for huge HCCs.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Significance of Tumor Growth Rate (TGR) in Patients with Huge Hepatocellular Carcinoma Undergoing Transcatheter Arterial Chemoembolization

et al. 2022

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The prognostic value of the tumor growth rate (TGR) in huge hepatocellular carcinoma (HHCC) patients treated with transcatheter arterial chemoembolization (TACE) as an initial treatment remains unclear. This two-center retrospective study was conducted in 97 patients suffering from HHCC. Demographic characteristics, oncology characteristics, and some serological markers were collected for analysis. The TGR was significantly linear and associated with the risk of death when applied to restricted cubic splines. The optimal cut-off value of TGR was −8.6%/month, and patients were divided into two groups according to TGR. Kaplan–Meier analysis showed that the high-TGR group had a poorer prognosis. TGR (hazard ratio (HR), 2.06; 95% confidence interval (CI), 1.23–3.43; p = 0.006), presence of portal vein tumor thrombus (PVTT) (HR, 1.93; 95% CI, 1.13–3.27; p = 0.016), and subsequent combination therapy (HR, 0.59; 95% CI, 0.35–0.99; p = 0.047) were independent predictors of OS in the multivariate analysis. The model with TGR was superior to the model without TGR in the DCA analysis. Patients who underwent subsequent combination therapy showed a longer survival in the high-TGR group. This study demonstrated that higher TGR was associated with a worse prognosis in patients with HHCC. These findings will distinguish patients who demand more personalized combination therapy and rigorous surveillance.

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Section: Discussionmentioning

confidence: 99%

“…Only some selected patients have a chance of gaining a curative surgery [ 2 , 3 ]. Transcatheter arterial chemoembolization (TACE) is an effective safety treatment to improve the prognosis of HHCC [ 4 , 5 ]. Some patients suffering from unresectable HHCC can switch to resectable tumors by means of preoperative TACE [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Tumor Growth Rate (TGR) in Patients with Huge Hepatocellular Carcinoma Undergoing Transcatheter Arterial Chemoembolization

et al. 2022

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“…Interestingly, Hidaka et al. reported that TACE for those with huge HCC (>10 cm) may also lead to rHCC ( 102 ), and a post-TACE huge HCC rupture can be successfully treated using interventional procedures. Tu et al.…”

Section: Transarterial Embolization/transarterial Chemoembolization F...mentioning

confidence: 99%

Ruptured Hepatocellular Carcinoma: What Do Interventional Radiologists Need to Know?

Yan

Deng

et al. 2022

Front. Oncol.

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Rupture of HCC (rHCC) is a life-threatening complication of hepatocellular carcinoma (HCC), and rHCC may lead to a high rate of peritoneal dissemination and affect survival negatively. Treatment for rHCC mainly includes emergency surgery, interventional therapies, and palliative treatment. However, the management of rHCC should be carefully evaluated. For patients with severe bleeding, who are not tolerant to open surgery, quick hemostatic methods such as rupture tissue ablation and TAE/TACE can be performed. We described clinical presentation, prognosis, complication, interventional management, and current evidence of rHCC from the perspective of interventional radiologists. Overall, our review summarized that interventional therapies are necessary for most patients with rHCC to achieve hemostasis, even in some patients with Child–Pugh C. Moreover, TAE/TACE followed by staged hepatectomy is a beneficial treatment for rHCC according to current clinical evidence. TAE/TACE is the first choice for most patients with rHCC, and appropriate interventional treatment may provide staged surgery opportunities for those who are not tolerant to emergency surgery to reach an ideal prognosis.

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“…Therefore, the outcomes of cTACE for huge HCC may be more strongly influenced by the TACE technique compared with cTACE for small HCC. Bland embolization with gelatin sponge particles followed by cTACE is another alternative option for huge HCC to safely embolize the tumor [83].…”

Section: Usefulness Of Stepwise Ctace For Large Hccsmentioning

confidence: 99%

“…Bland embolization, DEB-TACE, or systemic therapy is another option, especially for elderly patients. Bland embolization followed by cTACE is also another option to safely embolize the huge tumor [83]. For bilobar multiple lesions ≥4, superselective cTACE is not always indicated but the embolized area should be minimized to reduce liver toxicity.…”

Section: Tace Strategy According To the Number And Size Of Hccmentioning

confidence: 99%

Treatment Strategy of Transarterial Chemoembolization for Hepatocellular Carcinoma

Miyayama

2020

Applied Sciences

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Transarterial chemoembolization (TACE) is a first-line treatment for patients with hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer stage B (BCLC-B). There are two major techniques of TACE: conventional TACE (cTACE) using iodized oil and gelatin sponge particles, and TACE using drug-eluting beads (DEB-TACE). The latest randomized controlled trial proved the superiority of cTACE regarding local effects over DEB-TACE; however, cTACE also damages the liver more severely. Therefore, cTACE should be performed for localized HCCs as selectively as possible. On the other hand, DEB-TACE has less liver toxicity and is favorable for patients with an advanced age, large and/or bilobar tumors, or a poor liver function. However, some BCLC-B HCCs are TACE-resistant and the concept of TACE unsuitability (mainly up-to-7 criteria out) has been proposed by Asia-Pacific Primary Liver Cancer Expert Meeting. Systemic therapy is recommended for patients with TACE-unsuitable HCC; however, the condition of TACE-unsuitable HCC does not always rule out TACE monotherapy and some up-to-7 criteria out tumors may also be good candidates for superselective cTACE when localized in limited liver segments. The sequential therapy of an antiangiogenic and TACE is also a novel option for patients with TACE-unsuitable HCC, antiangiogenic-refractory HCC, or even down-staged HCC.

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Efficacy of combined bland embolization and chemoembolization for huge (≥10 cm) hepatocellular carcinoma

Cited by 13 publications

References 21 publications

Prognostic Significance of Tumor Growth Rate (TGR) in Patients with Huge Hepatocellular Carcinoma Undergoing Transcatheter Arterial Chemoembolization

Prognostic Significance of Tumor Growth Rate (TGR) in Patients with Huge Hepatocellular Carcinoma Undergoing Transcatheter Arterial Chemoembolization

Ruptured Hepatocellular Carcinoma: What Do Interventional Radiologists Need to Know?

Treatment Strategy of Transarterial Chemoembolization for Hepatocellular Carcinoma

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