<p>Efficacy and Safety of Supplemental Transarterial Chemoembolization Through Extrahepatic Collateral Arteries with Drug-eluting Beads: Treatment for Unresectable Hepatocellular Carcinoma</p>
“…There were 2,528 patients undergoing conversion therapy and 331 patients undergoing surgical resection after successful conversion therapy. Conversion therapies included TACE monotherapy [nine studies ( 15 , 17 , 18 , 21 – 24 )] or TACE combined with other therapies [nine studies ( 11 – 16 , 19 , 20 )]. All patients were diagnosed with HCC by pathology or non-invasive methods (imaging, serology, etc.).…”
Section: Resultsmentioning
confidence: 99%
“…All studies mentioned liver function, and the included patients had a normal liver function or compensatory cirrhosis (Child–Pugh score A or B). Some articles ( 11 , 13 , 14 , 16 , 18 , 20 , 21 , 23 ) also evaluated the Eastern Cooperative Oncology Group performance status (ECOG PS) of the enrolled patients. The main characteristics of the studies are summarized in Table 1 .…”
Section: Resultsmentioning
confidence: 99%
“…Among the nine studies ( 15 , 17 , 18 , 21 – 24 ) on TACE monotherapy, six ( 15 , 18 , 21 – 24 ) used conventional TACE (cTACE) conversion therapy and three ( 17 , 18 , 21 ) used drug-eluting bead TACE (DEB-TACE) conversion therapy. Of the remaining nine studies ( 11 – 16 , 19 , 20 ), five ( 12 , 15 , 16 , 19 , 20 ) reported bigeminy therapy and four ( 11 , 13 , 14 , 16 ) reported triple therapy.…”
BackgroundHepatocellular carcinoma (HCC) is a highly malignant disease with poor prognosis, and most cases were already considered unresectable at the time of presentation. Conversion therapy, as an emerging treatment, is designed to provide patients with initially unresectable hepatocellular carcinoma (uHCC) the opportunity to undergo radical resection. At present, conversion therapy for patients with uHCC remains controversial. Transarterial chemoembolization (TACE) is currently the most widely selected treatment for uHCC, but its efficacy as a conversion therapy remains controversial.MethodsWe compared and evaluated the conversion rate for and tumor response to TACE monotherapy or combination therapy. Meanwhile, postoperative complications and overall survival (OS) in uHCC patients who underwent conversion therapy were also analyzed.ResultsA total of 18 studies were included in this meta-analysis. The conversion rate for triple therapy [TACE in combination with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs)] was 42% [95% confidence interval (CI), 0.29–0.56], higher than any other group [TACE monotherapy: 10% (95% CI, 0.08–0.12), bigeminy therapy: 19% (95% CI, 0.06–0.36)]. Meanwhile, triple therapy yielded a better tumor response than TACE monotherapy or bigeminy therapy. Among the patients with successful surgical resection after conversion therapy, the pooled postoperative OS rates at 1, 2, and 5 years were 90% (95% CI, 0.81–0.97), 58% (95% CI, 0.42–0.73), and 42% (95% CI, 0.26–0.60), respectively, and the major postoperative complications were biliary leakage (7%; 95% CI, 0.03–0.12) and liver failure (3%; 95% CI, 0.00–0.07).ConclusionTACE conversion therapies showed good conversion rates, especially the triple therapy of TACE in combination with TKIs and ICIs. Surgical resection after successful conversion therapy could maximize the outcome of patients with uHCC.
“…There were 2,528 patients undergoing conversion therapy and 331 patients undergoing surgical resection after successful conversion therapy. Conversion therapies included TACE monotherapy [nine studies ( 15 , 17 , 18 , 21 – 24 )] or TACE combined with other therapies [nine studies ( 11 – 16 , 19 , 20 )]. All patients were diagnosed with HCC by pathology or non-invasive methods (imaging, serology, etc.).…”
Section: Resultsmentioning
confidence: 99%
“…All studies mentioned liver function, and the included patients had a normal liver function or compensatory cirrhosis (Child–Pugh score A or B). Some articles ( 11 , 13 , 14 , 16 , 18 , 20 , 21 , 23 ) also evaluated the Eastern Cooperative Oncology Group performance status (ECOG PS) of the enrolled patients. The main characteristics of the studies are summarized in Table 1 .…”
Section: Resultsmentioning
confidence: 99%
“…Among the nine studies ( 15 , 17 , 18 , 21 – 24 ) on TACE monotherapy, six ( 15 , 18 , 21 – 24 ) used conventional TACE (cTACE) conversion therapy and three ( 17 , 18 , 21 ) used drug-eluting bead TACE (DEB-TACE) conversion therapy. Of the remaining nine studies ( 11 – 16 , 19 , 20 ), five ( 12 , 15 , 16 , 19 , 20 ) reported bigeminy therapy and four ( 11 , 13 , 14 , 16 ) reported triple therapy.…”
BackgroundHepatocellular carcinoma (HCC) is a highly malignant disease with poor prognosis, and most cases were already considered unresectable at the time of presentation. Conversion therapy, as an emerging treatment, is designed to provide patients with initially unresectable hepatocellular carcinoma (uHCC) the opportunity to undergo radical resection. At present, conversion therapy for patients with uHCC remains controversial. Transarterial chemoembolization (TACE) is currently the most widely selected treatment for uHCC, but its efficacy as a conversion therapy remains controversial.MethodsWe compared and evaluated the conversion rate for and tumor response to TACE monotherapy or combination therapy. Meanwhile, postoperative complications and overall survival (OS) in uHCC patients who underwent conversion therapy were also analyzed.ResultsA total of 18 studies were included in this meta-analysis. The conversion rate for triple therapy [TACE in combination with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs)] was 42% [95% confidence interval (CI), 0.29–0.56], higher than any other group [TACE monotherapy: 10% (95% CI, 0.08–0.12), bigeminy therapy: 19% (95% CI, 0.06–0.36)]. Meanwhile, triple therapy yielded a better tumor response than TACE monotherapy or bigeminy therapy. Among the patients with successful surgical resection after conversion therapy, the pooled postoperative OS rates at 1, 2, and 5 years were 90% (95% CI, 0.81–0.97), 58% (95% CI, 0.42–0.73), and 42% (95% CI, 0.26–0.60), respectively, and the major postoperative complications were biliary leakage (7%; 95% CI, 0.03–0.12) and liver failure (3%; 95% CI, 0.00–0.07).ConclusionTACE conversion therapies showed good conversion rates, especially the triple therapy of TACE in combination with TKIs and ICIs. Surgical resection after successful conversion therapy could maximize the outcome of patients with uHCC.
“…Most studies focusing on using TACE through EHC arteries have been limited to cTACE, 40 and a retrospective study with 42 HCC patients treated with 30–60 µm Hepasphere beads through EHC arteries showed that DEB-TACE has a potential therapeutic effect on HCC tumors with an EHC blood supply, with a comparable safety level to cTACE. 41 Small-caliber DEBs can be super-selectively delivered to more distal branches of these EHC arteries, preventing non-target embolization of non-liver organs ( Figure 5 ). Figure 5 Extrahepatic collateral blood supply to HCC.…”
Section: Recommended Selection For Small-caliber (<100 μM) Debsmentioning
Drug-eluting beads transarterial chemoembolization (DEB-TACE) is an alternative to conventional lipiodol-based TACE (cTACE) to treat hepatocellular carcinoma (HCC). With the advancement in pharmacology, small-caliber DEB-TACE (<100 μm) has been introduced since 2016. For the treatment of hepatic neoplasms or HCC, there is a tendency to use smaller beads by DEB-TACE to achieve more extensive tumor necrosis and a significant reduction in liver toxicity in comparison with that caused by cTACE. However, the indications and potential complications of small-caliber DEB-TACE remain uncertain and have not been well established, due to lack of randomized phase III clinical trials. Instead of systematic or meta-analysis review, this narrative review article describes the suggested indications and contraindications of DEB-TACE with small DEBs, benefit of super-selective embolization of the feeding arteries and the recommended selection of small-caliber DEB. This review was approved by the institutional review board (File Number: 1-105-05-158).
“…13 DEB-TACE also revealed its superiority compared to cTACE in the treatment of HCC with a hypovascular pattern 14 and extrahepatic collateral blood supply. 15 However, at present, the role of DEB-TACE in treating advanced HCC with HAVS remains undetermined.…”
Background: To compare the efficacy and safety of combination therapy with sorafenib and drug-eluting bead transarterial chemoembolization (DEB-TACE) in advanced hepatocellular carcinoma (HCC) with or without hepatic arteriovenous shunt (HAVS). Methods: This retrospective, single-center study enrolled 59 advanced HCC patients treated with combination therapy, of whom 33 (55.9%) patients had HAVS. Tumor response according to the mRECIST criteria was evaluated based on the CT images 1 month after TACE, and changes in the arterial enhancement ratio (AER) of tumors and portal vein tumor thrombosis were also documented. Time-to-progression (TTP), overall survival (OS), and prognostic factors were analyzed. Safety was evaluated with the incidence of TACE-related complications within 6 weeks after TACE. Results: The tumor response between the two groups showed no significant difference in the objective response rate (69.2% in the group without HAVS vs 60.6% in the group with HAVS, p = 0.492) or disease control rate (92.3% vs 87.9%, p = 0.685). The two groups showed comparable TTP (4.23 vs 2.33 months, p = 0.235) and OS (12.77 vs 12.97 months, p = 0.910). A drop in the AER of tumors of more than 20% on post-TACE CT independently predicted better OS. With regard to safety, there was no significant difference between the two groups. Conclusion: For advanced HCC, combination therapy had equal efficacy and safety in patients with HAVS compared to those without HAVS, indicating that DEB-TACE is an optional and effective treatment in these patients.
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