Safety and Efficacy of Drug-eluting Bead Chemoembolization for Hepatocellular Carcinoma: Comparison of Small-versus Medium-size Particles

Padia, Siddharth A.; Shivaram, Giridhar M.; Bastawrous, Sarah; Bhargava, Puneet; Vo, Nghia J.; Vaidya, Sandeep; Valji, Karim; Harris, William Proctor; Hippe, Daniel S.; Kogut, Matthew J.

doi:10.1016/j.jvir.2012.11.023

Cited by 85 publications

(72 citation statements)

References 21 publications

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“…[10, [19][20][21][22] In the current study, the overall median and mean survivals from the time of 1st DEB TACE were 15.6 and 19.6 months accordingly, which is comparable with the reported DEB TACE studies.…”

Section: [17]supporting

confidence: 84%

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Transcatheter arterial chemoembolization in recurrent unresectable hepatocellular carcinoma after orthotopic liver transplantation

Prajapati¹,

Kavali²

2017

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How to cite this article: Prajapati HJ, Kavali P, Kim HS. Transcatheter arterial chemoembolization in recurrent unresectable hepatocellular carcinoma after orthotopic liver transplantation. Hepatoma Res 2017;3:182-8. Aim:To investigate the survivals and efficacy of the doxorubicin drug eluting beads transcatheter arterial chemoembolization (TACE) in patients with recurrent hepatocellular carcinoma (HCC) status post orthotopic liver transplantation. Methods: Consecutive patients with HCC who underwent orthotopic liver transplantation from 2005 to 2012 were reviewed. Patients who developed recurrent HCC after orthotopic liver transplantation and received doxorubicin drug eluting beads TACE therapy were identified and included in the study. Survivals were calculated from the time of 1st doxorubicin drug eluting beads TACE of recurrent HCC. Kaplan Meier estimator with log rank test was used for survival analysis. Results: Eight patients had recurrent HCC after orthotopic liver transplantation and received doxorubicin drug eluting beads TACE. The overall median survival of these patients was 15.6 months. Two patients had significantly poorer overall median survival from doxorubicin drug eluting beads TACE (3.4 months) and both showed elevated serum alpha-fetoprotein levels (> 400 ng/mL) and extra-hepatic metastases (P = 0.03). Patients with poorly differentiated HCC in explant liver had the poor median overall survival (3.6 months) compared to the patients with well-to-moderately differentiated HCC (21.7 months, P = 0.004). Conclusion: Doxorubicin drug eluting beads TACE appears to be an effective treatment option for patients with recurrent HCC after orthotopic liver transplantation.

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Section: [17]supporting

confidence: 84%

“…[10, [19][20][21][22] DEB TACE has demonstrated improved survival, better tolerability, and fewer side effects as compared to conventional TACE. [19,[21][22][23] In these reported DEB TACE studies, the survivals in patients with unresectable HCC, ranged from 13.5 to 24.5 months.…”

Section: [17]mentioning

confidence: 99%

Transcatheter arterial chemoembolization in recurrent unresectable hepatocellular carcinoma after orthotopic liver transplantation

Prajapati¹,

Kavali²

2017

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“…However, a study from Padia et al 15 that compared the safety of small (100 -300 μm) and mediumsize (300 -500 μm) particles, showed that the incidence of postembolization syndrome was lower in the first group and corresponded to 8%. In our study, we also used 100 -300 μm beads and this rate compares better with our results.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for the Development of Postembolization Syndrome after Transarterial Chemoembolization for Hepatocellular Carcinoma Treatment

et al. 2018

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RESUMOIntrodução: A quimioembolização hepática é uma técnica amplamente usada para o tratamento do carcinoma hepatocelular. A principal complicação deste procedimento é a síndrome pós-quimioembolização. O principal objetivo deste estudo foi determinar fatores de risco para síndrome pós-quimioembolização. Material e Métodos: Análise retrospetiva unicêntrica de 563 procedimentos de quimioembolização hepática efetuados entre 1/1/2014-31/12/2015. A quimioembolização hepática foi efetuada com ½ -2 ampolas de microesferas 100 -300 μm carregadas com doxorrubicina. Os pacientes que desenvolveram síndrome pós-quimioembolização foram identificados pelo prolongamento do internamento por dor, febre, náuseas e/ou vómitos. Um grupo controlo com os pacientes que não desenvolveram síndrome pós-quimioembolização foi criado de forma randomizada (três controlos para um caso). Foi realizada análise descritiva e regressão logística multivariada. Resultados: A prevalência global de síndrome pós-quimioembolização foi 6,2%. Quimioembolização hepática com dose de doxorrubicina superior a 75 mg (mais de uma ampola), o tamanho do nódulo maior e o género feminino demonstraram relação estatisticamente significativa com o desenvolvimento de síndrome pós-quimioembolização (p = 0,030, p = 0,046 e p = 0,037, respetivamente , 2015. Hepatic transarterial chemoembolization was performed with ½ -2 vials of 100 -300 μm microspheres loaded with doxorubicin. Patients who experienced postembolization syndrome were identified based on prolongation of hospitalization due to pain, fever, nausea and/or vomiting. A control group with the patients who did not have postembolization syndrome was randomly created (three controls for one case). Descriptive analysis and multivariate logistic regression were performed. Results: The overall prevalence of postembolization syndrome was 6.2%. Hepatic transarterial chemoembolization with doxorubicin dosage above 75 mg (more than one vial), the size of the largest nodule and female gender had statistically significant relation with development of postembolization syndrome (p = 0.030, p = 0.046 and p = 0.037, respectively). Discussion: Doxorrubicin dosage above 75 mg is associated with a higher risk of postembolization syndrome. This result can be helpful for decision-making in clinical practice, whenever it is possible to avoid a higher dose without compromising the efficacy of the treatment. The size of the largest nodule and female gender also constitute risk factors for postembolization syndrome. The other variables studied were not related to the development of postembolization syndrome. Conclusion:The dose of doxorrubicin, the size of the largest nodule treated and female gender are potential risk factors for the development of postembolization syndrome after hepatic transarterial chemoembolization for hepatocellular carcinoma.

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“…Epirubicin was chosen based on its use in cTACE in Asian countries and the approval status of anthracycline drugs for hepatic arterial infusion in Japan. The dose of epirubicin was determined based on recent studies [11][12][13] in which the anthracycline doxorubicin was used at a dose of 50 mg. We set the dose of epirubicin at 75 mg, which is equivalent in potency to 50 mg of doxorubicin. Selective embolization using a microcatheter was performed according to the technical recommendations of Lencioni et al [6].…”

Section: Deb-tace Proceduresmentioning

confidence: 99%

Feasibility Study of Transcatheter Arterial Chemoembolization with Epirubicin Drug-eluting Beads for Hepatocellular Carcinoma in Japanese Patients

Ishii

Sone

Sugawara

et al. 2017

Interventional Radiology

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Purpose: To evaluate the feasibility of drug-eluting bead (DEB)-transarterial chemoembolization (TACE) with 75 mg epirubicin for hepatocellular carcinoma (HCC) in Japanese patients with unresectable HCC prior to conducting a planned randomized controlled trial.Materials and Methods: This study was conducted as a prospective multi-center feasibility study. Eligible patients had unresectable Barcelona Clinic Liver Cancer stage A or B HCC that was unsuitable for curative treatments, and all patients received TACE with 75 mg epirubicin-loaded DEB. Tumor response, as the primary endpoint, was assessed after 4 weeks by computed tomography or magnetic resonance imaging, based on the modified Response Evaluation Criteria in Solid Tumors. Adverse events after treatment were evaluated as the secondary endpoint, based on the Common Terminology Criteria for Adverse Events version 4.0.Results: Between May and August 2014, 8 patients from two institutions were enrolled in this clinical study. There were no instances of complete response observed, partial response was obtained in 4 patients, and the overall response rate was 50%. No patients experienced grade 4 or higher adverse events. Grade 3 thrombocytopenia occurred in 1 patient. One patient experienced a grade 3 increase in aspartate aminotransferase, alanine aminotransferase, and bilirubin levels. All adverse events were well managed with conservative medical care. There were no procedure-related deaths.Conclusions: DEB-TACE with 75 mg epirubicin was found to be feasible in Japanese patients, and it was deemed appropriate to proceed to a randomized controlled trial comparing DEB-TACE and conventional TACE.

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Safety and Efficacy of Drug-eluting Bead Chemoembolization for Hepatocellular Carcinoma: Comparison of Small-versus Medium-size Particles

Cited by 85 publications

References 21 publications

Transcatheter arterial chemoembolization in recurrent unresectable hepatocellular carcinoma after orthotopic liver transplantation

Transcatheter arterial chemoembolization in recurrent unresectable hepatocellular carcinoma after orthotopic liver transplantation

Risk Factors for the Development of Postembolization Syndrome after Transarterial Chemoembolization for Hepatocellular Carcinoma Treatment

Feasibility Study of Transcatheter Arterial Chemoembolization with Epirubicin Drug-eluting Beads for Hepatocellular Carcinoma in Japanese Patients

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