DEB TACE for Intermediate and advanced HCC - Initial Experience in a Brazilian Cancer Center.
BACKGROUND
According to Barcelona Clinic Liver Cancer classification transarterial chemoembolization is indicated in patients with Hepatocellular Carcinoma in the intermediate stage. Drug-eluting microspheres can absorb and release the chemotherapeutic agent slowly for 14 days after its intra-arterial administration. This type of transarterial chemoembolization approach appears to provide at least equivalent effectiveness with less toxicity.


METHODS
This is a prospective, single-center study, which evaluated 21 patients with intermediate and advanced hepatocellular carcinoma who underwent transarterial chemoembolization with drug-eluting microspheres. The follow up period was 2 years. Inclusion criteria was Child-Pugh A or B liver disease patients, intermediate or advanced hepatocellular carcinoma and performance status equal or below 2. Transarterial chemoembolization with drug-eluting microspheres was performed at 2-month intervals during the first two sessions. The third and subsequent sessions were performed according to the image findings on follow-up, on a "demand schedule". Tumor response and time to progression were evaluated along the two-year follow up period.


RESULTS
Of the 21 patients 90% presented with liver cirrhosis, 62% had Barcelona Clinic Liver Cancer stage B and 38% had Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma. Average tumor size was 6.9 cm. The average number of Transarterial chemoembolization with drug-eluting microspheres procedures was 3 with a total of 64 sessions. The predominant toxicity was mild. Liver function was not significantly affected in most patients. Two deaths occurred within 90 days after Transarterial chemoembolization with drug-eluting microspheres (ischemic hepatitis and hydropic decompensation). Technical success was achieved in 63 of 64 procedures. The mean hospital stay was 1.5 days. The progression free and overall survival at 1 and 2 years were 73.0% and 37.1%, 73.7% and 41.6%, respectively.


CONCLUSIONS
Transarterial chemoembolization with drug-eluting microspheres is able to deliver significant tumor response and progression free survival rate with acceptable toxicity. Larger studies are needed to identify exactly which subset of advanced hepatocellular patients may benefit from this treatment.


BACKGROUND
study ID ISRCTN16295622. Registered October 14th 2016. Retrospectively registered. Website registration: http://www.isrctn.com/ISRCTN16295622.
Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil. jhugoluz@gmail.com.
Jose Hugo Mendes
JH
Luz
National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil.
Paula M
PM
Luz
Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil.
Henrique S
HS
Martin
Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil.
Hugo R
HR
Gouveia
Department of Interventional Radiology, Radiology Division, Hospital Federal de Bonsucesso, Avenida Londres, 616, Bonsucesso, Rio de Janeiro, 21041-030, Brazil.
Raphal Braz
RB
Levigard
Department of Interventional Radiology, Radiology Division, Hospital Federal de Bonsucesso, Avenida Londres, 616, Bonsucesso, Rio de Janeiro, 21041-030, Brazil.
Felipe Diniz
FD
Nogueira
Department of Interventional Radiology, Radiology Division, Hospital Federal de Ipanema, Rua Antônio Parreiras, 67, Ipanema, Rio de Janeiro, 22411-020, Brazil.
Bernardo Caetano
BC
Rodrigues
Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil.
Tiago Nepomuceno
TN
de Miranda
Department of Anatomy and Radiology, Full Professor, Medicine School - UFMG, Avenida Presidente Antônio Carlos, 6627 Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
Marcelo Henrique
MH
Mamede
D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D001938:Brazil / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D018450:Disease Progression; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin