Superselective Chemoembolization of HCC: Comparison of Short-term Safety and Efficacy between Drug-eluting LC Beads, QuadraSpheres, and Conventional Ethiodized Oil Emulsion.
OBJECTIVE
To study the comparative short-term safety and efficacy of transcatheter arterial chemoembolization (TACE) with drug-eluting LC Beads loaded with doxorubicin (DEBDOX), doxorubicin-eluting QuadraSpheres (hqTACE), and conventional TACE using ethiodized oil for superselective C-arm computed tomography (CT)-guided treatment of hepatocellular carcinoma (HCC) after the onset of drug shortages.


METHODS
From March 2010 to March 2011, 166 patients with HCC were treated with 232 superselective TACE procedures using C-arm cone-beam CT at one institution. Patients underwent treatment depending on the availability of materials after the onset of drug shortages. Conventional TACE with doxorubicin, cisplatin, and Ethiodol was performed for 159 procedures, DEBDOX TACE was performed for 47, and hqTACE was performed for 26. Toxicity and objective response were compared at 3 months after treatment. Data were stratified for the high-risk population (Child-Pugh class B, performance status 1, bilobar disease, and/or post-resection recurrence) and initial versus repeat treatment. Kruskal-Wallis H test, Mann-Whitney U test, and Fisher exact test were used to compare the groups, with Bonferroni correction where needed.


RESULTS
Whole liver response rates trended higher for conventional TACE (conventional TACE, 65.4%; DEBDOX, 63.8%; hqTACE, 53.8%) (P = .085). Only minor trends for differences in toxicity were observed between the three groups. Low-risk patients had higher whole liver (P = .001) and treated lesion (P = .007) response rates when treated with conventional TACE, but no significant differences were seen for DEBDOX and hqTACE. Treatment-naive patients also had higher whole liver (P = .012) and treated lesion (P = .056) response rates. No advantages for drug-eluting microspheres were found.


CONCLUSIONS
Within statistical power limitations, overall toxicity and efficacy were equivalent in patients treated with LC Beads, QuadraSpheres, or ethiodized oil emulsions, including in high-risk patients, when performed superselectively with cone-beam C-arm CT guidance.
From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3646, Stanford, CA 94305-5642.
Feng
F
Duan
From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3646, Stanford, CA 94305-5642.
Ellen Q
EQ
Wang
From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3646, Stanford, CA 94305-5642.
Marnix G E H
MG
Lam
From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3646, Stanford, CA 94305-5642.
Mohamed H K
MH
Abdelmaksoud
From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3646, Stanford, CA 94305-5642.
John D
JD
Louie
From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3646, Stanford, CA 94305-5642.
Gloria L
GL
Hwang
From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3646, Stanford, CA 94305-5642.
Nishita
N
Kothary
From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3646, Stanford, CA 94305-5642.
William T
WT
Kuo
From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3646, Stanford, CA 94305-5642.
Lawrence V
LV
Hofmann
From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3646, Stanford, CA 94305-5642.
Daniel Y
DY
Sze
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D054893:Cone-Beam Computed Tomography; D003287:Contrast Media; D004317:Doxorubicin / Q000008:administration & dosage*; D004337:Drug Carriers; D004655:Emulsions; D004998:Ethiodized Oil / Q000008:administration & dosage*; D005260:Female; D005780:Gelatin; D006801:Humans; D007472:Iohexol; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D016896:Treatment Outcome
D003287:Contrast Media; D004337:Drug Carriers; D004655:Emulsions; D007472:Iohexol; D004998:Ethiodized Oil; D004317:Doxorubicin; D005780:Gelatin