Transarterial bland versus chemoembolization for hepatocellular carcinoma: rethinking a gold standard

Massarweh, Nader N.; Davila, Jessica A.; El–Serag, Hashem B.; Duan, Zhenfeng; Temple, Sarah; May, Sarah; Sada, Yvonne; Anaya, Daniel A.

doi:10.1016/j.jss.2015.09.034

Cited by 22 publications

(17 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Randomized controlled data has suggested reduced toxicity and with DEB-TACE compared with conventional TACE in Child Pugh B patients with advanced or recurrent disease (16). Transarterial bland embolization (TAE) is not currently recommended (5) despite large scale retrospective data that suggests comparable efficacy to TACE (17, 18). Furthermore, a recent single blind randomized controlled trial by Brown et al further demonstrated equality between TAE and TACE with regard to RECEIST response, adverse events, and overall survival in HCC patients (19).…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency vs Microwave Ablation After Neoadjuvant Transarterial Bland and Drug-Eluting Microsphere Chembolization for the Treatment of Hepatocellular Carcinoma

Thornton

Cabrera

Kapp

et al. 2017

Current Problems in Diagnostic Radiology

View full text Add to dashboard Cite

Aim To retrospectively compare the initial response, local recurrence, and complication rates of radiofrequency ablation (RFA) vs microwave ablation (MWA) when combined with neoadjuvant bland transarterial embolization (TAE) or drug eluting microsphere chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC). Methods A total of 35 subjects with BCLC very early and early stage HCC (range 1.2 – 4.1 cm) underwent TAE (23) or TACE (12) with RFA (15) or MWA (20) from 1/2009–6/2015 as either definitive therapy or a bridge to transplant. TAE and TACE were performed with 40–400 μm particles and 30–100 μm plus either Doxorubicin or Epirubicin eluting microspheres respectively. Initial response and local progression were evaluated using modified Response Evaluation Criteria in Solid Tumors (mRECIST). Complications were graded using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results Complete response (CR) rates were 80% (12/15) for RFA + TAE/TACE and 95% (19/20) for MWA + TAE/TACE (p value 0.29). Local recurrence (LR) was 30% (4/12) for RFA + TAE/TACE and 0% (0/19) for MWA + TAE/TACE. Durability of response (DR), defined as local disease control for duration of the study, demonstrated a significant difference in favor of MWA (p value 0.0091). There was no statistical difference in complication rates (3 vs 2). Conclusions MWA and RFA when combined with neoadjuvant TAE or TACE have similar safety and efficacy in the treatment of early stage HCC. MWA provided more durable disease control in this study, however, prospective data remains necessary to evaluate superiority of either modality.

show abstract

Section: Discussionmentioning

confidence: 99%

Radiofrequency vs Microwave Ablation After Neoadjuvant Transarterial Bland and Drug-Eluting Microsphere Chembolization for the Treatment of Hepatocellular Carcinoma

Thornton

Cabrera

Kapp

et al. 2017

Current Problems in Diagnostic Radiology

View full text Add to dashboard Cite

show abstract

“…Tsochatzis et al [43] published results from a meta-analysis of six randomized controlled trials comparing TAE with TACE, and none of them revealed significant differences in overall survival [43,48]. Lee et al [49] summarized evidence from three studies revealing no significant differences in 3-year survival rates, adverse events, or RECIST responses [49][50][51][52]. Interestingly, Kluger et al [50] found that TAE patients were significantly less likely to require retreatment before transplantation than TACE patients.…”

Section: Prognostic Factors and Outcomesmentioning

confidence: 99%

Locoregional Therapy Approaches for Hepatocellular Carcinoma: Recent Advances and Management Strategies

Makary

Khandpur

Cloyd

et al. 2020

Cancers

View full text Add to dashboard Cite

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and third leading cause of cancer-related mortality worldwide. While surgical resection and transplantation are the standard first-line treatments for early-stage HCC, most patients do not fulfill criteria for surgery. Fortunately, catheter-directed and percutaneous locoregional approaches have evolved as major treatment modalities for unresectable HCC. Improved outcomes have been achieved with novel techniques which can be employed for diverse applications ranging from curative-intent for small localized tumors, to downstaging or bridging to resection and transplantation for early and intermediate disease, and locoregional control and palliation for advanced disease. This review explores recent advances in liver-directed techniques for HCC including bland transarterial embolization, chemoembolization, radioembolization, and ablative therapies, with a focus on patient selection, procedural technique, periprocedural management, and outcomes.

show abstract

“…With the application of polyvinyl alcohol, trisacryl gelatin microspheres (embospheres; Merit Medical Systems, Inc., South Jordan, UT, USA) and drugeluting beads, the common iodized oil TACE technique has been challenged by one that uses microspheres for the treatment of liver tumors. 9,10 A recent large overview analyzed three meta-analyses of TACE vs TAE; none of them found any significant difference between the two techniques. 5 However, another study found that, compared to TAE, TACE significantly prolonged progression-free survival (PFS) and time to progression (TTP), but not overall survival (OS).…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of transcatheter arterial chemoembolization with embospheres in treatment of hepatocellular carcinoma

Hao

Lin

Chen

et al. 2017

J of Digest Diseases

View full text Add to dashboard Cite

OBJECTIVE:To investigate the safety and efficacy of transcatheter arterial chemoembolization (TACE) with embospheres for the treatment of unresectable hepatocellular carcinoma (HCC). METHODS:Patients with unresectable HCC who were treated with TACE followed by embosphere treatment (Embo-TACE) or conventional TACE (cTACE) between May 2010 and March 2014 were retrospectively included in this study. The Embo-TACE group received lipiodol and chemotherapeutic agent emulsion, followed by embospheres. The cTACE group received lipiodol and chemotherapeutic agent emulsion, followed by gelatin sponge pellets. Time to progression (TTP), overall survival (OS), overall response rate (ORR), and safety were compared between the two groups. Univariate and multivariate regression analyses of the factors affecting survival were conducted. RESULTS:The median TTP and OS in the Embo-TACE group were significantly longer than those in the cTACE group (TPP: 7.0 months vs 5.4 months, P = 0.035; OS: 15 months vs 12 months, P = 0.032). Seven days after the first TACE treatment, alanine aminotransferase level was higher in the cTACE group than in the Embo-TACE group (P = 0.015). The ORR did not significantly differ between the two groups (P = 0.827). Additional therapy and local responses one month after the first TACE treatment were associated with OS. CONCLUSIONS:Embo-TACE resulted in a significant improvement in TTP and OS for patients with unresectable HCC, compared with cTACE. Furthermore, Embo-TACE was better tolerated. Additional therapy and local responses one month after the first TACE were independent prognostic factors for OS.

show abstract

Transarterial bland versus chemoembolization for hepatocellular carcinoma: rethinking a gold standard

Cited by 22 publications

References 29 publications

Radiofrequency vs Microwave Ablation After Neoadjuvant Transarterial Bland and Drug-Eluting Microsphere Chembolization for the Treatment of Hepatocellular Carcinoma

Radiofrequency vs Microwave Ablation After Neoadjuvant Transarterial Bland and Drug-Eluting Microsphere Chembolization for the Treatment of Hepatocellular Carcinoma

Locoregional Therapy Approaches for Hepatocellular Carcinoma: Recent Advances and Management Strategies

Safety and efficacy of transcatheter arterial chemoembolization with embospheres in treatment of hepatocellular carcinoma

Contact Info

Product

Resources

About