Does lesion enhancement pattern correlate between baseline MR and follow-up CT in patients with hepatocellular carcinoma (HCC) treated using conventional transarterial chemoembolization (cTACE)? A quantitative, multi-modality analysis

Abstract Background: To evaluate the clinical outcomes of patients who received stereotactic body radiation therapy (SBRT) for single viable hepatocellular carcinoma (HCC) at the site of incomplete transarterial chemoembolization (TACE).Methods: Incomplete TACE was defined as (1) evidence of viable HCC at the site of TACE on follow-up images following one or more consecutive TACEs, (2) no definite tumor staining on celiac angiogram, or (3) no definite iodized oil uptake on post-embolization angiogram or computed tomography. A total of 302 patients were treated between 2012 and 2017 at Asan Medical Center (Seoul, South Korea). Doses of 10–15 Gy per fraction were given over 3–4 consecutive days. Treatment-related adverse events were evaluated according to the common terminology criteria for adverse events, version 4.03.Results: The median follow-up duration was 32.9 months (interquartile range [IQR], 23.6–41.7) and the median tumor size was 2.0 cm (range, 0.7–6.9). The local control (LC) and overall survival rates at 3 years were 91.2% and 72.7%, respectively. 95.4% of the tumors reached complete response (CR) during the entire follow-up period (anyCR). The median interval from SBRT to anyCR was 3.4 months (IQR, 1.9–4.7), and 39.9% and 83.3% of the lesions reached CR at 3- and 6-months after SBRT, respectively. Radiation-induced liver disease was observed in 8 (2.6%) patients. No patients experienced gastroduodenal bleeding within the radiation field.Conclusion: SBRT should be considered a feasible salvage treatment option for HCC after incomplete TACE.

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Transarterial Chemoembolization Using 100-μm Drug-Eluting Microspheres in Patients with Hepatocellular Carcinoma: A Prospective Study and Midterm Follow-up

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2020.06.009 ◽

2020 ◽

Vol 31 (11) ◽

pp. 1784-1791

Author(s):

Hsin-You Ou ◽

Ying-Nong Wu ◽

Chun-Yen Yu ◽

Chao-Long Chen ◽

Hsien-Wen Hsu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prospective Study ◽

Transarterial Chemoembolization ◽

Drug Eluting ◽

A Prospective Study

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As Clinical Markers, Hand-Foot-Skin Reaction and Diarrhea Can Predict Better Outcomes for Hepatocellular Carcinoma Patients Receiving Transarterial Chemoembolization plus Sorafenib

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2019/2576349 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Lei Liu ◽

Enxin Wang ◽

Lin Li ◽

Dongyu Chen ◽

Kun Peng ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Combination Therapy ◽

Skin Reaction ◽

Transarterial Chemoembolization ◽

Cox Regression ◽

Time Dependent ◽

Clinical Markers ◽

Study Population ◽

Hand Foot Skin Reaction

Background. Combination therapy of transarterial chemoembolization plus sorafenib (TACE-S) has been proven to be safe and effective for hepatocellular carcinoma (HCC); however, this combination therapy is associated with a high incidence of adverse events (AEs). Our study focused on the relationships between AEs and treatment outcomes and aimed to discover AE-based clinical markers that can predict the survival benefits of combination treatment. Methods. From January 2010 to June 2014, a total of 235 HCC patients treated with TACE-S were retrospectively enrolled. Major sorafenib-related AEs were prospectively recorded, and their correlations with overall survival (OS) were analysed using time-dependent covariate Cox regression analyses. Results. The majority of the patients (200, 85.1%) were male, and the median age was 51 years old. After two years of follow-up, the median OS of the study population reached 12.4 months. In all, 218 patients (92.8%) presented at least one AE, and 174 (74.0%) suffered AEs ≥2 grade. Based on time-dependent multivariate analyses, the development of hand-foot skin reaction (HFSR) ≥2 grade (HR = 0.43, 95% CI: 0.32–0.58, P<0.001) and diarrhoea ≥1 grade (HR = 0.72, 95% CI: 0.53–0.97, P=0.029) were identified as independent predictors of prolonged OS. Moreover, patients who developed both HFSR ≥2 grade and diarrhoea ≥1 grade achieved better outcomes than those patients who developed either or neither of these AEs (HR = 1.51, 95% CI: 1.11–2.06, P=0.009). Conclusions. The development of HFSR ≥2 grade or diarrhoea ≥1 grade during TACE-S treatment indicated prolonged OS, and these AEs should be considered important clinical markers for predicting patient prognoses.

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Long-term follow-up after conventional transarterial chemoembolization (c-TACE) with mitomycin for hepatocellular carcinoma (HCC)

Journal of Gastrointestinal Oncology ◽

10.21037/jgo.2019.01.01 ◽

2019 ◽

Vol 10 (2) ◽

pp. 348-353 ◽

Cited By ~ 3

Author(s):

Ricardo Yamada ◽

Beatriz Bassaco ◽

Stephen Bracewell ◽

Kirkpatrick Gillen ◽

Madison Kocher ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Transarterial Chemoembolization ◽

Long Term Follow Up

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Balloon-occluded chemoembolization for hepatocellular carcinoma: a prospective study of safety, feasibility and outcomes

Hepatic Oncology ◽

10.2217/hep-2020-0022 ◽

2020 ◽

Author(s):

Ana-Maria Bucalau ◽

Illario Tancredi ◽

Martina Pezzullo ◽

Raphael Leveque ◽

Simona Picchia ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Transarterial Chemoembolization ◽

Overall Response Rate ◽

Response Rate ◽

Prospective Trial ◽

Evaluation Criteria ◽

Liver Decompensation ◽

A Prospective Study ◽

Imaging Response

Aim: Evaluation of safety and efficacy of selective balloon-occluded transarterial chemoembolization using polyethylene glycol embolizing microspheres in patients with hepatocellular carcinoma. Materials & methods: Twenty-four consecutive patients were included in this monocentric prospective trial. Adverse events were evaluated at 24 h and 1 month. Imaging response according to modified response evaluation criteria in solid tumors was assessed at 1, 3 and 6 months. Results: The median time of follow-up was of 22.8 months (interquartile range (IQR) 17.38–26.22). Clinical grade 1/2 toxicities (0% >grade 2) were reported in 25.7% of patients, with abdominal pain being the most frequent complication (17.1%). No 30-days mortalities or liver decompensation were observed. The 1-month follow-up MRI showed an overall response rate of 74.3% Conclusion: Balloon-occluded transarterial chemoembolization was shown to be safe and effective.

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Prospective phase II trial of sorafenib combined with doxorubicin eluting bead-transarterial chemoembolization for patients with unresectable hepatocellular carcinoma: Efficacy analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.4124 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 4124-4124

Author(s):

Jean-Francois Geschwind ◽

Allen Feng ◽

Diane K. Reyes ◽

Ihab R. Kamel ◽

Vivek Gowdra Halappa ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Phase Ii ◽

Transarterial Chemoembolization ◽

Phase Ii Study ◽

Rank Test ◽

Median Dose ◽

Unresectable Hepatocellular Carcinoma ◽

Significant Difference ◽

Prospective Phase

4124 Background: This study reports the final analysis (n=50) of a prospective phase II study evaluating the efficacy of the combination of sorafenib and doxorubicin eluting bead transarterial chemoembolization (DEB-TACE) in patients with unresectable hepatocellular carcinoma (HCC). Methods: Protocol consisted of 6-week cycles with sorafenib at 800 mg/day beginning 1 week prior to DEB-TACE; up to 4 DEB-TACE treatments within 6 months. Tumor response was assessed by RECIST and EASL criteria using MRI at baseline and at 1 month follow-up. Time to untreatable progression (TTUP) was defined as the interval from initiation of sorafenib therapy until inability of patient to further receive intra-arterial therapy. Overall survival (OS) and TTUP were calculated with the Kaplan-Meier method; outcomes were stratified by BCLC A/B and C and compared with the log-rank test. Results: DEB-TACE + sorafenib successfully performed in 50 patients: mean 62yrs (range, 31-88 yrs), Child-Pugh A/B (92%/8%), BCLC A/B/C (10%/28%/62%), ECOG 0/1 (52%/48%), HCV/HBV (44%/8%), mean tumor burden 20%, mean tumor size 7.2cm (range, 1–17.6), and mean tumor enhancement 78%. Patients were enrolled for a median of 3 (range, 1-22) cycles including a median of 1 (range, 0-6) DEB-TACE procedure. Median dose regimen was 400mgQD and the median dose taken while on study was 318 mg/day (range, 100-800). 1 month follow-up showed a mean tumor enhancement reduction of 48.2% (n=46, p<0.001) and an average reduction in lesion diameter of 8.5%(n=48, p=0.02). The Disease Control Rate was 98% using the EASL amendment and RECIST. Median TTUP was 11.9 mths (95% CI, 1.8-22 mths) with a significant difference between BCLC A/B (median 22.9 mths) and BCLC C (median 6.2mths) patients (log-rank, p=0.01). Median OS was 24.5 mths (95% CI, 14.3-35 mths) with a significant difference between BCLC C (median 17.1 mths) and BCLC A/B (median 33.7 mths) patients (log-rank, p=0.001). Conclusions: The results of this phase II study suggest a potential benefit to the combination of sorafenib and DEB-TACE. Single arm and non-randomization are limitations of the study. Clinical trial information: NCT00844883.

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Predicting Therapeutic Efficacy of Transarterial Chemoembolization with Drug-Eluting Beads for Hepatocellular Carcinoma Using Contrast-Enhanced Ultrasound

Diagnostics ◽

10.3390/diagnostics11020291 ◽

2021 ◽

Vol 11 (2) ◽

pp. 291

Author(s):

Kazue Shiozawa ◽

Takashi Matsui ◽

Takahiro Murakami ◽

Manabu Watanabe ◽

Iruru Maetani

Keyword(s):

Hepatocellular Carcinoma ◽

Transarterial Chemoembolization ◽

Therapeutic Efficacy ◽

Response Rates ◽

Contrast Enhanced Ultrasound ◽

Enhancement Pattern ◽

Contrast Enhanced ◽

Peripheral Ring ◽

Drug Eluting Beads ◽

Drug Eluting

The aim of this study was to assess the usefulness of contrast-enhanced ultrasound (CEUS) for predicting the therapeutic efficacy of transarterial chemoembolization with drug-eluting beads (DEB-TACE) for hepatocellular carcinoma (HCC). Thirty-two patients with HCC who underwent DEB-TACE were enrolled in this study. Enhancement patterns of vascular phase images on CEUS were compared before and within 3 days after DEB-TACE, and the patterns after DEB-TACE were classified as follows: Pattern A, no enhancement; Pattern B, peripheral ring enhancement; Pattern C, partial enhancement within or peripheral to tumors, and Pattern D, reduced or unchanged enhancement in the whole tumor. Enhancement patterns in all lesions and contrast-enhanced computed tomography (CECT) findings after DEB-TACE were compared statistically. The treatment response of DEB-TACE was evaluated using the Modified Response Evaluation Criteria in Solid Tumors (mRECIST) by CECT. The enhancement patterns on CEUS performed within 3 days after DEB-TACE were defined as Pattern A in 17 cases, B in 7, C in 13, and D in 2. The complete response rates at one month after treatment were 94.1% (16/17 lesions) for Pattern A, 85.7% (6/7) for B, 15.4% (2/13) for C, and 50% (1/2) for D. The response rates were significantly higher for lesions with Pattern A compared to those with Pattern C at one month (p = 0.009) and 12 months (p < 0.001) after treatment, and significantly higher for lesions with Pattern B compared to those with Pattern C at 12 months after treatment (p = 0.031). Comparisons between other patterns showed no significant differences. CEUS immediately after DEB-TACE may allow early assessment of therapeutic efficacy, with findings of no enhancement or peripheral ring enhancement suggesting a positive outcome.

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Sorafenib Versus Apatinib Both Combined Transarterial Chemoembolization for Hepatocellular Carcinoma With Portal Vein Tumor Thrombosis: A Comparative Retrospective Study

Frontiers in Oncology ◽

10.3389/fonc.2021.673378 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yanyan Cao ◽

Tao Sun ◽

Xiaopeng Guo ◽

Tao Ouyang ◽

Xuefeng Kan ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Adverse Events ◽

Portal Vein ◽

Transarterial Chemoembolization ◽

Tumor Response ◽

Portal Vein Tumor Thrombosis ◽

Time To Progression ◽

Tumor Thrombosis ◽

Tace Group

ObjectiveTo compare the efficacy and safety of transarterial chemoembolization (TACE) combining with sorafenib or apatinib for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT).MethodsFrom June 2015 to March 2020, a total of 89 consecutive advanced HCC patients with PVTT who were treated with sorafenib-TACE (S-TACE) or apatinib-TACE (A-TACE) in our center were enrolled. The overall survival (OS), time to progression (TTP), tumor response, and adverse events in the two groups were compared.ResultsThere were 32 and 41 patients included in the S-TACE group and A-TACE group, respectively. The median follow-up was 10.0 months (range, 3.0–36.0 months) in the whole study. The median OS (11.0 vs. 10.0 months, P = 0.419), median TTP (5.0 vs. 6.0 months, P = 0.073), and tumor response (P = 0.529) between the S-TACE group and the A-TACE group were not significantly different. The adverse events related to sorafenib or apatinib were tolerable.ConclusionS-TACE and A-TACE exhibited comparable prognosis for HCC patients with PVTT, which provide another effective and safe method of A-TACE for these patients except for conventional S-TACE.

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