Multidisciplinary Taiwan Consensus Recommendations for the Use of DEBDOX-TACE in Hepatocellular Carcinoma Treatment

Abstract

Transarterial chemoembolization (TACE) is the first-line treatment in patients with unresectable hepatocellular carcinoma (HCC). In recent years, there has been increasing clinical evidence that drug-eluting beads provide a combined ischemic and cytotoxic effect that may be superior to conventional TACE, with low systemic toxicity. The therapeutic value of TACE performed using the embolic microsphere DC Bead loaded with doxorubicin (drug-eluting bead doxorubicin [DEBDOX]) has been shown by several randomized controlled trials. Since Lencioni et al. [Cardiovasc Intervent Radiol 2012; 35: 980–985] published the first widely accepted technical recommendations on HCC embolization with DEBDOX-TACE in 2012, new studies have contributed to a better understanding of when and how to apply this new therapeutic modality, and they have yet to be incorporated into an updated guideline. Additionally, differences in the underlying liver pathology and practice of transcatheter embolization between Asian and Western populations have not been adequately addressed, and there remain significant variations in the TACE protocols adopted in different parts of the world. These mainly revolve around the number and type of chemotherapeutic agents used, type of embolic material, reliance on Lipiodol, and selectivity of catheter positioning. As a result of these issues, it has been difficult to interpret and compare results obtained from different centers in a systematic fashion. To address these concerns, we convened a panel of experts specializing in different aspects of HCC treatment to craft an updated set of recommendations that better reflect recent clinical experiences and are tailored to the use of DEBDOX-TACE in Taiwan. The conclusions of this expert panel are described in the following article.

ALBI and P-ALBI grade in Child-Pugh A patients treated with drug eluting embolic chemoembolization for hepatocellular carcinoma

“…However the particles used in that study were relatively large (majority of PVA was 355-500 µm), and it has been shown that poorer outcome and more complications can be related to larger (>300 µm) particles (213). The data on endpoints and use of additional bland embolization is otherwise relatively scarce and in expert panel guidelines whether to use additional bland embolization or not to obtain stasis is left to the decision of the interventionist (207,214).…”

“…Expert panels have acknowledged that a subgroup of BCLC C patients (e.g. segmental portal vein thrombus while Child-Pugh A) could benefit from TACE (141,152,201,207), and that TACE may safely be performed in these patients (208). This approach is also endorsed in the HKLC staging system (54).…”

Clinical management of vascular lake during transarterial chemoembolization with CalliSpheres drug-eluting beads (DEBs) for the treatment of hepatocellular carcinoma

“…In Cavalcante et al ’s practice, if VL was detected during the treatment, the TACE using DEBs or blank microspheres continued until the VL disappeared on a second angiography ( 11 ). According to Chang et al , if VL was found, embolization with gelatin sponge particles was performed until the VL disappeared, so as to achieve better efficiency ( 19 ). In our current study, VLs were divided into stable or unstable types, and different treatments were applied.…”

Safety and Efficacy of Drug-Eluting Beads Trans-Arterial Chemoembolization for Hepatocellular Carcinoma in Taiwan (SERENADE-T)

“…All patients should have received a standardized DEBDOX-TACE treatment. Detailed DEBDOX-TACE technique has been previously described by Chang et al 9 Segmental or lobar DEBDOX-TACE was performed according to a local procedure with DC Bead of appropriate size, loaded with 50 to 75 mg of doxorubicin per 2 mL DC Bead. The total dose of doxorubicin administered depends on tumor size and tumor number by the same embolization endpoint.…”