Survival Rates in Hepatocellular Carcinoma Patient Treated by Transarterial Chemoembolization: Comparison withOperable and Inoperable Cases

Hepatocellular carcinoma is the fifth most common cancer worldwide and the approaches to treatmentdiffer due to the stage of the disease. According to BCLC classification, B stage patients are recommendedto be underwent transarterial chemoembolization. However, BCLC B integrates patients with differentintrahepatic tumor burden and with different liver deterioration. There are many staging classifications thatdetermine the treatment and survival rates due to heterogeneity of this patient cohort. The aim of this studyis to review the existing ones and to describe their prognostic value.

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Stereotactic body radiation therapy following transarterial chemoembolization for Child-Pugh A and B hepatocellular carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.321 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 321-321

Author(s):

Craig Joseph Baden ◽

Benjamin Hinton ◽

Rojymon Jacob

Keyword(s):

Hepatocellular Carcinoma ◽

Radiation Therapy ◽

Local Control ◽

Transarterial Chemoembolization ◽

Stereotactic Body Radiation Therapy ◽

Respiratory Gating ◽

Survival Rates ◽

Progression Free Survival ◽

Survival Times ◽

Stereotactic Body Radiation

321 Background: Hepatocellular carcinoma (HCC) incidence continues to increase, but recent improvements in treatment of localized tumors have contributed to modest gains in survival rates. Though transarterial chemoembolization (TACE) and stereotactic body radiation therapy (SBRT) are increasingly used in the management of unresectable HCC, outcomes data regarding the combination of these treatments is limited. Here we report institutional outcomes for patients with Child-Pugh A (CPA) and B HCC treated with TACE followed by SBRT. Methods: We completed an institutional retrospective review of all patients treated with combination TACE and SBRT between 2009 and 2013. After compiling dosimetry, toxicity, and outcomes data for each patient we calculated descriptive statistics for the cohort and determined local control (LC), distant liver control (DLC), progression free survival (PFS), and overall survival (OS) utilizing the Kaplan-Meier method. We also compared these disease-related outcomes between CPA and CPB groups with the Mantel-Cox test for equality. Results: Thirty-one patients with HCC, median age 65, were treated with TACE and SBRT and followed for a median 16.6 months (range: 6.2-50.8). Twenty-two patients had CPA disease and 9 CPB at the time of initial treatment. Following TACE and a median interval of 10.5 days (range: 4.4-25.6) patients underwent SBRT, the majority (23) with 45 Gy in 3 fractions. All but 3 patients were treated with respiratory gating, and all had cone-beam CT for image guidance. One and 2 year disease-related outcomes were as follows: LC 92.0 and 82.8%, DLC 81.5 and 61.0%, PFS 73.6 and 61.8%, OS 96.8 and 64.2%. There were no statistically significant differences between CPA or CPB patients with respect to any of these disease-related outcome measures. Median survival times for class A and B patients were 34.2 months (95% CI 12.3-56.1) and 27.2 months (14.9-39.5) respectively. Conclusions: The combination of TACE and SBRT is generally well tolerated, and results in very good local control in both CPA and CPB patients. Distant liver failure remains a major problem in these patients and requires further study.

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Combined transarterial chemoembolization and radiofrequency ablation for small treatment-naïve hepatocellular carcinoma infeasible for ultrasound-guided radiofrequency ablation: long-term outcomes

Acta Radiologica ◽

10.1177/0284185117735349 ◽

2017 ◽

Vol 59 (7) ◽

pp. 773-781 ◽

Cited By ~ 8

Author(s):

Dongho Hyun ◽

Sung Ki Cho ◽

Sung Wook Shin ◽

Kwang Bo Park ◽

Sang Yub Lee ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factors ◽

Radiofrequency Ablation ◽

Transarterial Chemoembolization ◽

Survival Rates ◽

Event Free Survival ◽

Long Term Outcomes ◽

Free Survival ◽

Treatment Naïve

Background Ultrasound (US)-guided radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC) is often infeasible due to unfavorable location and poor conspicuity. Those small HCCs can be treated with combined transarterial chemoembolization (TACE) and RFA. Purpose To evaluate long-term outcomes of combined TACE and RFA for small treatment-naïve HCC infeasible for US-guided RFA. Material and Methods Between February 2009 and January 2014, 69 patients with small (≤3 cm) HCC infeasible for US-guided RFA received TACE and subsequent RFA in one session as a first-line treatment. Local tumor progression (LTP), overall survival (OS), and event-free survival rates were evaluated. Univariate and multivariate analyses were conducted to identify prognostic factors. Results Cumulative rates of LTP were 4.4%, 6.8%, 8.2%, 9.5%, and 9.5% at one, two, three, five, and seven years, respectively. Cumulative one-, two-, three-, five-, and seven-year OS rates were 100%, 95%, 89%, 80%, and 80%, respectively. Cumulative one-, two-, three-, five-, and seven-year event-free survival rates were 81%, 63%, 54%, 31%, and 20%, respectively. No significant prognostic factors for LTP, OS, and event-free survival were identified in univariate analysis. Conclusion Combined TACE and RFA appears to be an effective treatment for small treatment-naïve HCC infeasible for US-guided RFA in terms of LTP and OS.

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Efficacy of Superselective Conventional Transarterial Chemoembolization Using Guidance Software for Hepatocellular Carcinoma within Three Lesions Smaller Than 3 cm

Cancers ◽

10.3390/cancers13246370 ◽

2021 ◽

Vol 13 (24) ◽

pp. 6370

Author(s):

Shiro Miyayama ◽

Masashi Yamashiro ◽

Rie Ikeda ◽

Junichi Matsumoto ◽

Kiyotaka Takeuchi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Transarterial Chemoembolization ◽

Survival Rates ◽

Safety Margin ◽

Complete Response ◽

Hepatic Arteriography ◽

Conventional Tace ◽

Dual Blood Supply ◽

Lost To Follow Up

The indication of transarterial chemoembolization (TACE) has advanced to hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage A when surgical resection (SR), thermal ablation, and bridging to transplantation are contraindicated; however, TACE for small HCC is frequently difficult and ineffective because of less hypervascularity and the presence of tumor portions receiving a dual blood supply. Here, we report outcomes of superselective conventional TACE (cTACE) for 259 patients with HCCs within three lesions smaller than 3 cm using guidance software. Automated tumor feeder detection (AFD) functionality was applied to identify tumor feeders on cone-beam computed tomography during hepatic arteriography (CBCTHA) data. When it failed, the feeder was identified by manual feeder detection functionality and/or selective angiography and CBCTHA. Regarding the technical success in 382 tumors (mean diameter, 17.2 ± 5.9 mm), 310 (81.2%) were completely embolized with a safety margin (5 mm wide for HCC ≤25 mm and 10 mm wide for HCC >25 mm). In 61 (16.0%), the entire tumor was embolized but the safety margin was not uniformly obtained. The entire tumor was not embolized in 11 (2.9%). Regarding the tumor response at 2–3 months after cTACE in 303 tumors excluding those treated with combined radiofrequency ablation (RFA) or SR and lost to follow-up, 287 (94.7%) were classified into complete response, seven (2.3%) into partial response, and nine (3.0%) into stable disease. The mean follow-up period was 44.9 ± 27.6 months (range, 1–109) and the cumulative local tumor progression rates at 1, 3, 5, and 7 years were 17.8, 27.8, 32.0, and 36.0%, respectively. The 1-, 3-, 5-, and 7-year overall and recurrence-free survival rates in 175 patients, excluding those with Child–Pugh C class, who died of other malignancies, or who underwent combined RFA or hepatic resection, were 97.1 and 68.7, 82.8 and 34.9, 64.8 and 20.2, and 45.3 and 17.3%, respectively. Our results indicate the efficacy of superselective cTACE using guidance software for HCC within three lesions smaller than 3 cm.

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Gene signature predictive of hepatocellular carcinoma patient response to transarterial chemoembolization

International Journal of Biological Sciences ◽

10.7150/ijbs.39534 ◽

2019 ◽

Vol 15 (12) ◽

pp. 2654-2663 ◽

Cited By ~ 1

Author(s):

Valerie Fako ◽

Sean P. Martin ◽

Yotsawat Pomyen ◽

Anuradha Budhu ◽

Jittiporn Chaisaingmongkol ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Transarterial Chemoembolization ◽

Gene Signature ◽

Patient Response ◽

Carcinoma Patient

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Complex treatment of hepatocellular carcinoma at early (BCLC-A) and intermediate (BCLC-B) stages

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2020255-66 ◽

2020 ◽

Vol 25 (2) ◽

pp. 55-66

Author(s):

B. N. Kotiv ◽

I. I. Dzidzava ◽

S. A. Alent’yev ◽

A. V. Smorodsky ◽

K. I. Makhmudov ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Targeted Therapy ◽

Radiofrequency Ablation ◽

Liver Resection ◽

Transarterial Chemoembolization ◽

Survival Rates ◽

Locoregional Therapy ◽

Group 2 ◽

Group 1

Аim. Evaluation of the effectiveness of hepatocellular carcinoma treatment at early BCLC-A and intermediate BCLC-B stages by the combined use of liver resections and locoregional therapy.Materials and methods. The study included 142 patients with hepatocellular carcinoma. At the BCLC-A stage – 46 observations, at the BCLC-B stage – 96 observations. Chronic hepatitis and cirrhosis of various etiologies were detected in 58 (40.8%) patients. Liver resection of various volumes, transarterial chemoembolization and radiofrequency ablation were used for treatment. With the tumor progression and the ineffectiveness of locoregional therapy, targeted therapy was prescribed.Results. Four groups of patients were identified depending on treatment tactics. In group 1, 28 patients underwent radical liver resections; in group 2, 37 patients underwent preoperative transarterial chemoembolization and liver resection. In group 3, 63 patients underwent therapeutic transarterial chemoembolization and radiofrequency ablation. In group 4, 14 patients underwent transarterial chemoembolization followed by hepatic arterial infusion of chemotherapy and targeted therapy. Overall survival in groups 1 and 2 significantly exceeds survival rates in groups 3 and 4. The median overall survival in groups 1–4 was 39, 37.5, 19.5, and 7.5 months (p1–3 = 0.0001 ; p1–4 = 0.0009, p2–3 = 0.018 , p 2–4 = 0.001). The cumulative one, three and five year survival rates in groups 1 and 2 did not significantly differ (87.8% and 80.0%, 82.5% and 75.0%, 68.2% and 58.0%, 54.5% and 41.0%, respectively, p1–2 = 0.076). However, group 1 consisted exclusively of patients with BCLC-A stages with solitary tumors less than 6.5 cm in diameter, group 2 included large BCLC-A tumors and multiple tumors BCLC-B stages (67.6%).Conclusion. For the treatment of patients with hepatocellular carcinoma BCLC-A and BCLC-B stages, a multimodal approach should be applied, including differential use and a rational combination of regional chemotherapy and resection techniques, taking into account the functional state of the liver.

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Postoperative adjuvant transarterial chemoembolization improves the prognosis of hepatocellular carcinoma patients with microvascular invasion: a systematic review and meta-analysis

Acta Radiologica ◽

10.1177/0284185119878357 ◽

2019 ◽

Vol 61 (6) ◽

pp. 723-731

Author(s):

Lian Li ◽

Bo Li ◽

Ming Zhang

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Recurrence Rate ◽

Transarterial Chemoembolization ◽

Meta Analysis ◽

Survival Rates ◽

Microvascular Invasion ◽

Recurrence Rates ◽

The One ◽

Overall Survival Rates

Background Microvascular invasion has been widely accepted as a major risk factor of hepatocellular carcinoma prognoses after surgery. It is still controversial whether postoperative adjuvant transarterial chemoembolization could improve the survival of hepatocellular carcinoma patients with microvascular invasion. Purpose To evaluate the effect of postoperative adjuvant transarterial chemoembolization for postoperative hepatocellular carcinoma patients with microvascular invasion. Material and Methods PubMed, Web of Science, and Embase databases were searched for eligible studies, and the one-, three-, and five-year recurrence rates and overall survival rates were extracted for meta-analysis. Results A total of eight studies were included in this study. The results showed that the one-, three-, and five-year recurrence rate of the postoperative adjuvant transarterial chemoembolization group were better than those of the hepatectomy alone group, with a pooled risk ratio (RR) of 0.66 (95% confidence interval [CI] 0.58–0.75, P < 0.00001), 0.82 (95% CI 0.76–0.88, P < 0.00001), and 0.89 (95% CI 0.82–0.97, P = 0.007), respectively. The overall survival rates with one-, three-, and five-year pooled RR were 0.34 (95% CI 0.25–0.47, P < 0.00001), 0.69 (95% CI 0.60–0.79, P < 0.00001), and 0.78 (95% CI 0.69–0.89, P = 0.0001), respectively. No serious side effects have been reported, indicating that postoperative intervention is safe. Conclusion For hepatocellular carcinoma patients with microvascular invasion confirmed by postoperative pathology, postoperative adjuvant transarterial chemoembolization is a safe treatment, which could reduce the tumor recurrence rate and improve the patient’s overall survival.

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