Tumor response and survival outcomes of very small drug-eluting beads used in trans-arterial chemoembolization for unresectable hepatocellular carcinoma

Abstract

and/or systolic blood pressure o100 mmHg) were present in 46% (16/35) of patients. Mean hemoglobin (Hb) level at presentation was 92 g/L (range 48-147). The diagnosis of HCC rupture, active bleeding and/or hemoperitoneum, was made with CT (33), ultrasound (1), or MRI (1). Solitary HCC was present in 34% (12/35) of patients. The mean ruptured HCC size was 7.7 cm (range 2.6-20.6). Polyvinyl alcohol (PVA) particles were used for TAE in 81% (29/36) of cases. Technical success, defined as absence of hemorrhage with vessel stasis on completion angiogram, was achieved in 97% (n ¼ 35/36) of TAE procedures. Clinical success, defined as stabilization of hemodynamic status and Hb levels, was achieved in 75% (27/36) of TAE procedures. One patient underwent a second TAE procedure which was also unsuccessful in achieving hemostasis and died within 24 hours. Serious complications were encountered in 29% (10/35) of patients, including acute liver failure (3), hepatorenal failure (2), encephalopathy (3), variceal bleeding (2), bacterial peritonitis (2), pulmonary embolism (1), pneumonia (1), and cardiac arrest (1). The 30-day mortality rate was 31% (11/35). Median overall survival was 4.3 months (range 0-34). In patients surviving at least 1 month, peritoneal metastases developed in 27% (6/22). Conclusions: TAE is an effective technique for hemodynamic stabilization in acute HCC rupture, but the overall prognosis remains guarded.

Electrochemotherapy as a New Modality in Interventional Oncology: A Review

“…In cases of hepatocellular carcinoma (HCC), a complete response of 23% and objective response of 66% as well as an improvement in survival can be observed after TACE. 82 , 83 When treating malignant liver metastases, a partial response rate up to 56% in the case of liver metastasis with neuroendocrine tumors (stable disease 40%), 84 partial response up to 11.5% in the case of liver metastases from pancreatic cancer (stable disease 78%), 85 and partial response up to 80% in the case of colorectal liver metastases (stable disease up to 48%) 86 were reported. As both therapy concepts are based on locoregional application of cytostatic in hepatocellular parenchyma, a similar response rate of ECT by liver lesions can be possible.…”