Advanced-stage hepatocellular carcinoma with portal vein thrombosis: conventional versus drug-eluting beads transcatheter arterial chemoembolization

Boris Gorodetski, Julius Chapiro, Ruediger Schernthaner, Rafael Duran, Ming De Lin, Howard Lee, David Lenis, Elizabeth A. Stuart, Bareng Aletta Sanny Nonyane, Vasily Pekurovsky, Anobel Tamrazi, Bernhard Gebauer, Todd Schlachter, Timothy M. Pawlik, Jean Francois Geschwind

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Objectives: Our study sought to compare the overall survival in patients with hepatocellular carcinoma (HCC) and portal venous thrombosis (PVT), treated with either conventional trans-arterial chemoembolization (cTACE) or drug-eluting beads (DEB) TACE. Methods: This retrospective analysis included a total of 133 patients, treated without cross-over and compared head-to-head by means or propensity score weighting. Mortality was compared using survival analysis upon propensity score weighting. Adverse events and liver toxicity grade ≥3 were recorded and reported for each TACE. In order to compare with historical sorafenib studies, a sub-group analysis was performed and included patients who fulfilled the SHARP inclusion criteria. Results: The median overall survival (MOS) of the entire cohort was 4.53 months (95 % CI, 3.63–6.03). MOS was similar across treatment arms, no significant difference between cTACE (N = 95) and DEB-TACE (N = 38) was observed (MOS of 5.0 vs. 3.33 months, respectively; p = 0.157). The most common adverse events after cTACE and DEB- TACE, respectively, were as follows: post-embolization syndrome [N = 57 (30.0 %) and N = 38 (61.3 %)], diarrhea [N = 3 (1.6 %) and N = 3 (4.8 %)], and encephalopathy [N = 11 (5.8 %) and N = 2 (3.2 %)]. Conclusion: Our retrospective study could not reveal a difference in toxicity and efficiency between cTACE and DEB-TACE for treatment of advanced stage HCC with PVT. Key Points: • Conventional TACE (cTACE) and drug-eluting-beads TACE (DEB-TACE) demonstrated equal safety profiles. • Survival rates after TACE are similar to patients treated with sorafenib. • Child-Pugh class and tumor burden are reliable predictors of survival.

Original languageEnglish (US)
Pages (from-to)526-535
Number of pages10
JournalEuropean radiology
Volume27
Issue number2
DOIs
StatePublished - Feb 1 2017

Keywords

  • Adverse effects
  • Chemoembolization
  • Hepatocellular carcinoma
  • Liver
  • Propensity score

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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