Outcomes of conventional transarterial chemoembolization for hepatocellular carcinoma ≥10 cm

Abstract

Aim To retrospectively evaluate the outcomes of conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC) ≥10 cm. Methods Twenty‐five patients with naïve HCC ≥10 cm (mean maximum tumor diameter, 130 ± 27.6 mm; single [n = 12], 2–9 [n = 6], and ≥10 [n = 7]) without extrahepatic spread treated with cTACE were eligible. Five (20%) had vascular invasion. Two to three stepwise cTACE sessions using iodized oil ≤10 mL in one cTACE session were scheduled. When the tumor recurred, additional cTACE was repeated on demand, if possible. Overall survival (OS) rates were calculated using the Kaplan–Meier method. The prognostic factors were evaluated using uni‐ and multivariate analyses. Results Stepwise cTACE sessions were completed for 20 (80%) patients, but could not be completed for four (16%). In the remaining (4%) patient, the whole tumor was embolized in one session. Additional treatment, mainly cTACE, was undertaken for 19 (76%) patients. The OS rates at 1, 3, and 5 years were 68, 34.7, and 23.1%, respectively. A tumor number of three was a significant prognostic factor (P = 0.020) and the 1‐, 3‐, and 4‐year OS rates in patients with ≤3 and ≥4 tumors were 81.3 and 33.3, 55.6 and 11.1, and 38.9% and 0%, respectively. Whole tumor embolization and the serum level of protein induced by vitamin K absence or antagonist‐II were also significant prognostic factors (P < 0.001 and P = 0.042, respectively). Bile duct complications requiring additional interventions developed in two (8%) patients. Conclusion Conventional TACE is safe and effective for huge HCCs, but has limited effects in cases with four or more tumors.

Chemoembolization for Single Large Hepatocellular Carcinoma with Preserved Liver Function: Analysis of Factors Predicting Clinical Outcomes in a 302 Patient Cohort

“…The corresponding median OS times were 141, 55, and 28 months, respectively. Our study is different from others since previous studies investigating TACE for single large HCC only included huge HCCs (> 10 cm) [20,21] or performed subgroup comparison of single large HCCs with heterogenous BCLC A or B HCCs [22]. Furthermore, previous risk prediction models were generated for inhomogeneous groups [10,23,24] or single small HCC (≤3 cm) [25].…”

Treatment Strategy of Transarterial Chemoembolization for Hepatocellular Carcinoma

“…In addition, the use of a large volume of iodized oil for large tumors carries the risk of catastrophic complications, such as systemic embolization of the lung or brain [78,79] and acute tumor-lysis syndrome [80]. Therefore, we typically perform stepwise superselective cTACE for localized tumors >7 cm [81,82]. Two to three cTACE sessions are scheduled depending on the vascular anatomy, and each session is performed in a superselective fashion using ≤10 mL of iodized oil at 3-to 10-week intervals according to the patient and tumor conditions.…”

“…Two to three cTACE sessions are scheduled depending on the vascular anatomy, and each session is performed in a superselective fashion using ≤10 mL of iodized oil at 3-to 10-week intervals according to the patient and tumor conditions. In our recent analysis of 25 patients with HCC ≥10 cm (mean, 130 ± 27.6 mm [range, , single [n = 12], 2-9 [n = 6, mean, 4.2 ± 2.6 ], and ≥10 tumors [n = 7, including 2 with ≥50 tumors], with vascular invasion [n = 5]), the 5-year survival rate was 23.1%, and that of patients with tumors ≤3 lesions was 38.9% [82]. This indicates that cTACE is also effective for localized huge HCCs.…”

“…This indicates that cTACE is also effective for localized huge HCCs. However, cTACE of extrahepatic collateral arteries was required in 84% of patients during the treatment course [82]. Therefore, the outcomes of cTACE for huge HCC may be more strongly influenced by the TACE technique compared with cTACE for small HCC.…”

“…For tumors ≤7 cm and ≤3 lesions, superselective cTACE, mainly ultraselective cTACE, is performed. For tumors >7 cm but ≤3 lesions, stepwise superselective cTACE is also performed with curative intent [81,82]. Bland embolization, DEB-TACE, or systemic therapy is another option, especially for elderly patients.…”