Transarterial Chemoembolization for Hepatocellular Carcinoma with a New Generation of Beads: Clinical–Radiological Outcomes and Safety Profile

Spreafico, Carlo; Cascella, Tommaso; Facciorusso, Antonio; Sposito, Carlo; Lanocita, Rodolfo; Morosi, Carlo; Civelli, Enrico; Vaiani, Marta; Bhoori, Sherrie; Pellegrinelli, Alessandro; Marchianò, Alfonso; Mazzaferro, Vincenzo

doi:10.1007/s00270-014-0907-0

Cited by 61 publications

(54 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…DEB-TACE has been shown to be safe and effective in palliative HCC treatment in several clinical and preclinical studies (27,(36)(37)(38)(39)(40)(41), as well as in a randomized clinical trial (RCT) comparing DEB-TACE with cTACE (23,26), but the evidence to support its use as a neoadjuvant treatment before OLT is scarce (25,(42)(43)(44)(45)(46). To our knowledge, this is the first clinical study that compares OS and DFS of patients that did and did not receive DEB-TACE before OLT and one of the largest series assessing neoadjuvant DEB-TACE clinical results in the literature so far.…”

Section: Discussionmentioning

confidence: 99%

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

Dorcaratto

Udupa²,

Hogan³

et al. 2017

Diagn Interv Radiol

View full text Add to dashboard Cite

O rthotopic liver transplant is the gold standard treatment for patients with hepatocellular carcinoma (HCC) within Milan criteria (1, 2). Conventional transarterial chemoembolization (cTACE) is widely accepted as a palliative treatment for patients who do not fulfill the criteria for OLT, HCC resection, or local therapies such as ethanol injection, radiofrequency ablation, microwave ablation, cryotherapy, or electroporation (3-11). The usefulness of pre-OLT TACE to avoid disease progression while waiting for organ allocation and to down-stage selected patients to fulfill transplant criteria is well known. However, the effect of neoadjuvant TACE treatment prior to OLT for HCC on overall survival (OS) and disease-free survival (DFS) is contentious (2,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).Doxorubicin drug-eluting bead TACE (DEB-TACE) is a drug delivery embolization system that can achieve higher tumor and lower systemic concentrations of doxorubicin compared with cTACE and demonstrated equal efficacy with low toxicity in previous clinical studies (23-27). However, the evidence to support the use of this relatively novel technique as a neoadjuvant treatment before OLT and its impact on OS and DFS is scarce.The aim of this study was to compare OS and DFS of patient undergoing OLT for HCC who did and did not receive neoadjuvant DEB-TACE. Methods Study design and populationData was investigated from a prospectively maintained database and the need to ob- I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to compare the overall (OS) and disease-free survival (DFS) of patients undergoing orthotopic liver transplant (OLT) for hepatocellular carcinoma who did and did not have neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization (DEB-TACE). METHODSThis is a retrospective study of 94 patients with HCC transplanted between 2000 and 2014 in a single tertiary center. Pre-and postoperative features, DFS and OS were compared between patients who received pre-OLT DEB-TACE (n=34, DEB-TACE group) and those who did not (n=60, non-TACE group). Radiologic and histologic response to neoadjuvant treatment as well as its complications were also studied. RESULTSThere were no significant differences in post-transplantation DFS and OS rates between groups (5-year DFS: 70% in DEB-TACE group vs. 63% in non-TACE group, P = 0.454; 5-year OS: 70% in DEB-TACE group vs. 65% in non-TACE group, P = 0.532). The DEB-TACE group had longer OLT waiting time compared with the non-TACE group (110 vs. 72 days; P = 0.01). On univariate and multivariate analyses, alpha-fetoprotein (AFP) levels >500 ng/mL prior to OLT were associated with decreased OS and DFS regardless of neoadjuvant approach (hazard ratio of 6, P = 0.001 and 5.5, P = 0.002, respectively). CONCLUSIONPatients who underwent neoadjuvant DEB-TACE and OLT for hepatocellular carcinoma had no statistically different OS or DFS at 3 and 5 years from patients undergoing OLT alone.You may cite this article as: Dorcaratto D, Udupa V, Ho...

show abstract

Section: Discussionmentioning

confidence: 99%

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

Dorcaratto

Udupa²,

Hogan³

et al. 2017

Diagn Interv Radiol

View full text Add to dashboard Cite

show abstract

“…15 Alpha fetoprotein (AFP) response was monitored in patients with serum AFP levels above >20 ng/mL at baseline. A decrease of at least 50% at 8 weeks after TACE was rated as response, if paralleled by radiologic criteria.…”

mentioning

confidence: 99%

Drug‐eluting beads versus conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma

Facciorusso

Mariani

Sposito

et al. 2016

J of Gastro and Hepatol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although the optimisation of drug delivery has focused on DEEs for several years [8,25], c-TACE still has an important role to play in transarterial HCC therapies. Lipiodol has a well-known toxicity profile as it has been used worldwide for more than 25 years [26]; it is able to reach portal venules through arterio-portal anastomoses, which may improve treatment response at the periphery of HCC and in satellite nodules [27]; it is cheap, and the two randomised phase III studies which demonstrated the survival benefits of TACE in unresectable HCC patients were designed with lipiodol as the vector for cisplatin [1] and doxorubicin [2].…”

Section: Discussionmentioning

confidence: 99%

Improved stability of lipiodol–drug emulsion for transarterial chemoembolisation of hepatocellular carcinoma results in improved pharmacokinetic profile: Proof of concept using idarubicin

et al. 2015

View full text Add to dashboard Cite

show abstract

Transarterial Chemoembolization for Hepatocellular Carcinoma with a New Generation of Beads: Clinical–Radiological Outcomes and Safety Profile

Abstract: DEBDOX/M1 TACE is an effective procedure with a favorable safety profile and promising results in terms of objective response rate, tumor downstaging, and necrosis.

Cited by 61 publications

References 20 publications

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

Drug‐eluting beads versus conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma

Improved stability of lipiodol–drug emulsion for transarterial chemoembolisation of hepatocellular carcinoma results in improved pharmacokinetic profile: Proof of concept using idarubicin

Contact Info

Product

Resources

About