Outcomes of patients (pts) with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE): Global OPTIMIS final analysis.

Peck‐Radosavljevic, Markus; Kudo, Masatoshi; Raoul, Jean-Luc; Lee, Han Chu; Decaens, Thomas; Heo, Jeong; Lin, Shi‐Ming; Song, Hong; Yang, Yue; Bayh, Inga; Nakajima, Keiko; Cheng, Ann‐Lii

doi:10.1200/jco.2018.36.15_suppl.4018

Cited by 79 publications

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“…Conventional TACE involves the intra‐arterial infusion of chemotherapy and embolization of the tumors' feeding vessels causing a local cytotoxic and ischemic effect 22 . Complete and partial tumor response to a first TACE treatment may be only 14% and 26%, respectively 28 . Previous studies evaluating TACE have shown improvements in median overall survival when compared with control, with median survival reaching at best up to 28.7 months, 6‐8 which is less than survival rates attributed to resection or ablation.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive microwave ablation provides excellent long‐term outcomes for otherwise inaccessible hepatocellular cancer

Altman

Coughlan

Shukla

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: Thermal ablation can be used as a bridge to transplant or with curative intent for hepatocellular carcinoma (HCC). We report our experience with laparoscopic ablation of HCC in patients deemed inaccessible by the percutaneous approach.Methods: We performed a retrospective review of surgical ablations from 2009 to 2017. Patient demographics, disease and treatment characteristics, and outcomes were abstracted from the medical record. Kaplan-Meier modeling was performed for survival and recurrence.Results: Thirty-three patients were included with a median age of 62 (interquartile range [IQR], 57-67). Most patients were male (76%) and Caucasian (70%). Ninety-seven percent had underlying cirrhosis. Median model for end stage liver disease-sodium was 9.5 (IQR,(8)(9)(10)(11)(12). The median maximal diameter of ablated lesions was 2.6 cm (IQR, 1.8-3.0). Thirty-nine lesions were ablated; 97% were completed laparoscopically. The median maximal diameter of the ablation zone was 4.8 cm (IQR, 3.8-5.7) with a median difference of ablation zone to the tumor of 2.0 cm (IQR, 1.5-2.75). Twelve patients received additional treatment. Median disease-free survival was 66.7 months and median follow-up 42.9 months. Disease recurrence occurred in 13 patients (39%)systemic recurrence in 6%, intrahepatic recurrence in 27% and local recurrence in 6%.Conclusion: Laparoscopic thermal ablation of HCC is safe and provides good oncologic outcomes for otherwise inaccessible tumors. K E Y W O R D S disease recurrence, hepatocellular carcinoma, laparoscopic surgery, minimally invasive surgery, thermal ablation

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Section: Discussionmentioning

confidence: 99%

Minimally invasive microwave ablation provides excellent long‐term outcomes for otherwise inaccessible hepatocellular cancer

Altman

Coughlan

Shukla

et al. 2020

Journal of Surgical Oncology

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“…switched to sorafenib, with the remaining 460 (90.7%) being selected for continued TACE but not sorafenib in the follow-up period. [18] This result suggests that a significant number of patients with HCC in the clinic are treated with TACE, despite the absence of an adequate indication based on the concept of TACE refractoriness. [18] Therefore, our findings, added to the OPTIMIS study results, clearly show that systemic therapy for HCC after TACE refractoriness is not commonly used in clinical settings and that the time for starting systemic therapy varies widely.…”

Section: Plos Onementioning

confidence: 99%

“…[18] This result suggests that a significant number of patients with HCC in the clinic are treated with TACE, despite the absence of an adequate indication based on the concept of TACE refractoriness. [18] Therefore, our findings, added to the OPTIMIS study results, clearly show that systemic therapy for HCC after TACE refractoriness is not commonly used in clinical settings and that the time for starting systemic therapy varies widely. In South Korea, once systemic therapy has been initiated for HCC, the national insurance program does not cover further TACE or other locoregional treatment options.…”

Section: Plos Onementioning

confidence: 99%

Evaluation of transarterial chemoembolization refractoriness in patients with hepatocellular carcinoma

et al. 2020

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Background & aimIn clinical practice, transarterial chemoembolization (TACE) has been widely used for the treatment of hepatocellular carcinoma (HCC) beyond as well as within guideline recommendations. Here we aimed to verify whether two consecutive non-responses could be an optimal criterion for creating a rule to stop TACE being performed on these patients. MethodsThis study evaluated 200 patients with HCC beyond the Milan criteria, initially treated with TACE. TACE response was determined using the mRECIST criteria via dynamic CT or MRI. Median follow-up duration was 23.9 months. ResultsWithin the 200 patients analyzed, 183 (91.5%) were male, with a total median age of 59.8 years. The mean size of the largest tumor was 6.8 cm, with 80 (40.0%) patients with �4 tumors. After the first TACE procedure, complete response, partial response, stable disease, or progressive disease were observed in 48 (24.0%), 87 (43.5%), 59 (29.5%) and 6 (3.0%) of patients, respectively. 45 (22.5%) patients showed no objective response (OR) following two consecutive TACE sessions. Of these, 28 received a subsequent TACE, with a 10.7% OR rate. Patients without OR showed poorer survival when compared to patients who achieved OR after repeated TACE. Multivariable analysis showed that size of the largest tumor >5cm and high alpha-fetoprotein of >200 ng/mL were significant factors associated with failure of OR to two consecutive TACE sessions. ConclusionPatients showing no OR to two consecutive TACE sessions will present a poor OR to subsequent TACE procedures. Early transition to systemic therapy may be advocated in such cases. PLOS ONEPLOS ONE | https://doi.org/10.

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“…Within the heterogeneous BCLC B stage, several controversies still concern the adequate timing for the transition from locoregional to systemic therapies. Whereas lack of response after two rounds of transarterial chemoembolization (TACE) or progression of previously treated lesions indicates locoregional treatment failures, in a real‐world setting, these findings do not necessarily lead to an anticipated shift toward a systemic strategy . On top of that, it appears that a sizeable fraction of BCLC C patients still receives upfront TACE, which may contribute to acute and chronic liver function deterioration, despite a clear indication for other treatment options.…”

mentioning

confidence: 99%

“…Whereas lack of response after two rounds of transarterial chemoembolization (TACE) or progression of previously treated lesions indicates locoregional treatment failures, in a real‐world setting, these findings do not necessarily lead to an anticipated shift toward a systemic strategy . On top of that, it appears that a sizeable fraction of BCLC C patients still receives upfront TACE, which may contribute to acute and chronic liver function deterioration, despite a clear indication for other treatment options. Therefore, the possibility to identify those patients who might benefit from earlier transitions to systemic treatments speaks to the crucial role played by multidisciplinary teams that convene surgeons, interventional radiologists, hepatologists, and medical oncologists.…”

mentioning

confidence: 99%

Which choice of therapy when many are available? Current systemic therapies for advanced hepatocellular carcinoma

Personeni

Pressiani

Rimassa

2020

Health Science Reports

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Outcomes of patients (pts) with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE): Global OPTIMIS final analysis.

Cited by 79 publications

References 0 publications

Minimally invasive microwave ablation provides excellent long‐term outcomes for otherwise inaccessible hepatocellular cancer

Minimally invasive microwave ablation provides excellent long‐term outcomes for otherwise inaccessible hepatocellular cancer

Evaluation of transarterial chemoembolization refractoriness in patients with hepatocellular carcinoma

Which choice of therapy when many are available? Current systemic therapies for advanced hepatocellular carcinoma

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