title: Safety and effectiveness of chemoembolization with drug-eluting beads for advanced-stage hepatocellular carcinoma.
abstract: BACKGROUND
  According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, patients with advanced stage (BCLC-C) hepatocellular carcinoma (HCC) are recommended for systemic treatment or palliative therapy. However, chemoembolization with drug-eluting beads (DEB-TACE) has been shown to be safe in high-risk patients. The purpose of our study was to evaluate the safety and effectiveness of DEB-TACE in patients with an advanced-stage HCC.
  
  
  METHODS
  In this institutional review board-approved, retrospective study, 80 patients with advanced-stage HCC underwent DEB-TACE with doxorubicin. Patients were evaluated for median hospital stay, incidence of Grade 3/4 toxicities, 30-day mortality, progression-free survival (PFS), and overall survival (OS) following DEB-TACE. Univariate and multivariate analysis were performed for predictors of better OS.
  
  
  RESULTS
  The median hospital stay following DEB-TACE was 1 day (range: 1-11). The median PFS and OS were 5.1 months [95% confidence interval (CI): 4.1-7.7] and 13.3 months (95% CI: 10.1-18.6) respectively. On multivariate analysis ECOG PS ≤ 1 and >2 DEB-TACE procedures were associated with better OS. Patients with ECOG PS ≤ 1 demonstrated a median survival of 17.7 months compared with 5.6 months for patients with ECOG PS > 1 (p = 0.025). Multiple DEB-TACE procedures (>2 procedures) were associated with improved survival (26.8 months) compared with patients with one or two procedures (11.4 months, p = 0.01). Portal vein thrombosis or extrahepatic disease had no statistically significant association with OS.
  
  
  CONCLUSIONS
  DEB-TACE is safe and effective in patients with advanced HCC. ECOG PS ≤ 1 and >2 DEB-TACE procedures were associated with better OS.
authors.affiliation: Interventional Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8834, USA, sanjeeva.kalva@utsouthwestern.edu.
authors.forename: Sanjeeva P
authors.initials: SP
authors.lastname: Kalva
authors.forename: Melina
authors.initials: M
authors.lastname: Pectasides
authors.forename: Raymond
authors.initials: R
authors.lastname: Liu
authors.forename: Niranjan
authors.initials: N
authors.lastname: Rachamreddy
authors.forename: Shravani
authors.initials: S
authors.lastname: Surakanti
authors.forename: Kalpana
authors.initials: K
authors.lastname: Yeddula
authors.forename: Suvranu
authors.initials: S
authors.lastname: Ganguli
authors.forename: Stephan
authors.initials: S
authors.lastname: Wicky
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Blaszkowsky
authors.forename: Andrew X
authors.initials: AX
authors.lastname: Zhu
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D015331:Cohort Studies; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage*; D004337:Drug Carriers / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods; D061214:Patient Safety; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004337:Drug Carriers; D004317:Doxorubicin