DEB TACE for Intermediate and advanced HCC – Initial Experience in a Brazilian Cancer Center
Tóm tắt
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. 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. 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. 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. study ID ISRCTN16295622. Registered October 14th 2016. Retrospectively registered. Website registration: http://www.isrctn.com/ISRCTN16295622
Tài liệu tham khảo
citation_journal_title=Semin Liver Dis; citation_title=Epidemiology of primary liver cancer; citation_author=FX Bosch, J Ribes, J Borras; citation_volume=19; citation_publication_date=1999; citation_pages=271-85; citation_doi=10.1055/s-2007-1007117; citation_id=CR1
citation_journal_title=N Engl J Med; citation_title=Sorafenib in advanced hepatocellular carcinoma; citation_author=JM Llovet, S Ricci, V Mazzaferro; citation_volume=359; citation_publication_date=2008; citation_pages=378-90; citation_doi=10.1056/NEJMoa0708857; citation_id=CR2
citation_journal_title=Semin Liver Dis; citation_title=Current strategy for staging and treatment: the BCLC update and future prospects; citation_author=A Forner, ME Reig, CR de Lope, J Bruix; citation_volume=30; citation_publication_date=2010; citation_pages=61-74; citation_doi=10.1055/s-0030-1247133; citation_id=CR3
citation_journal_title=Hepatology; citation_title=Management of hepatocellular carcinoma: an up-date; citation_author=J Bruix, M Sherman; citation_volume=53; citation_issue=3; citation_publication_date=2011; citation_pages=1020-2; citation_doi=10.1002/hep.24199; citation_id=CR4
citation_journal_title=J Hepatol; citation_title=Clinical management of hepatocellular carcinoma: conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver; citation_author=J Bruix, M Sherman, JM Llovet; citation_volume=35; citation_issue=3; citation_publication_date=2001; citation_pages=421-430; citation_doi=10.1016/S0168-8278(01)00130-1; citation_id=CR5
citation_journal_title=J Vasc Interv Radiol; citation_title=DC bead: in vitro characterization of a drug-delivery device for transarterial chemoembolization; citation_author=AL Lewis, MV Gonzalez, AW Lloyd; citation_volume=17; citation_publication_date=2006; citation_pages=335-342; citation_doi=10.1097/01.RVI.0000195323.46152.B3; citation_id=CR6
citation_journal_title=Clin Cancer Res; citation_title=New intra-arterial drug delivery system for the treatment of liver cancer: preclinical assessment in a rabbit model of liver cancer; citation_author=K Hong, A Khwaja, E Liapi; citation_volume=12; citation_publication_date=2006; citation_pages=2563-2567; citation_doi=10.1158/1078-0432.CCR-05-2225; citation_id=CR7
citation_journal_title=Cardiovasc Intervent Radiol; citation_title=Doxorubicin-loaded QuadraSphere microspheres: plasma pharmacokinetics and in- tratumoral drug concentration in an animal model of liver cancer; citation_author=KH Lee, EA Liapi, C Cornell; citation_volume=33; citation_publication_date=2010; citation_pages=576-82; citation_doi=10.1007/s00270-010-9794-1; citation_id=CR8
citation_journal_title=J Vasc Interv Radiol; citation_title=Comparative study of chemoembolization loadable beads: in vitro drug release and physical properties of DC bead and hepasphere loaded with doxorubicin and irinotecan; citation_author=O Jordan, A Denys, T De Baere, N Boulens, E Doelker; citation_volume=21; citation_publication_date=2010; citation_pages=1084-1090; citation_doi=10.1016/j.jvir.2010.02.042; citation_id=CR9
citation_journal_title=J Hepatol; citation_title=Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics; citation_author=M Varela, MI Real, M Burrel; citation_volume=46; citation_publication_date=2007; citation_pages=474-481; citation_doi=10.1016/j.jhep.2006.10.020; citation_id=CR10
citation_journal_title=J Hepat; citation_title=Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using Drug Eluting Beads. Implications for clinical practice and trial design; citation_author=M Burrel, M Reig, A Forner; citation_volume=56; citation_issue=6; citation_publication_date=2012; citation_pages=1330-35; citation_doi=10.1016/j.jhep.2012.01.008; citation_id=CR11
citation_journal_title=Hepatogastroenterology; citation_title=Safety and efficacy of transarterial chemoembolization with drug-eluting beads in hepatocellular cancer: a systematic review; citation_author=R Martin, D Geller, J Espat; citation_volume=59; citation_issue=113; citation_publication_date=2012; citation_pages=255-60; citation_id=CR12
citation_journal_title=Radiology; citation_title=TACE treatment in patients with sorafenib treated unresectable hepatocellular carcinoma in clinical practice: final analysis of GIDEON; citation_author=JF Geschwind, M Kudo, JA Marrero, AP Venook, XP Chen, JP Bronowicki; citation_volume=8; citation_publication_date=2016; citation_pages=150667; citation_id=CR13
citation_journal_title=Cardiovasc Intervent Radiol.; citation_title=Prospective randomised study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study; citation_author=J Lammer, K Malagari, T Vogl; citation_volume=33; citation_publication_date=2010; citation_pages=41-52; citation_doi=10.1007/s00270-009-9711-7; citation_id=CR14
citation_journal_title=Semin Liver Dis; citation_title=Modified RECIST (mRECIST) Assessment for Hepatocellular Carcinoma; citation_author=R Lencioni, JM Llovet; citation_volume=30; citation_publication_date=2010; citation_pages=52-60; citation_doi=10.1055/s-0030-1247132; citation_id=CR15
citation_journal_title=J Vasc Interv Radiol; citation_title=Hepatic artery embolization: factors predisposing to postembolization pain and nausea; citation_author=NH Patel, D Hahn, S Rapp; citation_volume=11; citation_publication_date=2000; citation_pages=453-460; citation_doi=10.1016/S1051-0443(07)61377-3; citation_id=CR16
citation_journal_title=J Vasc Interv Radiol; citation_title=Society of Interventional Radiology position statement on chemoembolization of hepatic malignancies; citation_author=DB Brown, JF Geschwind, MC Soulen; citation_volume=17; citation_issue=2 Pt 1; citation_publication_date=2006; citation_pages=217-223; citation_doi=10.1097/01.RVI.0000196277.76812.A3; citation_id=CR17
citation_journal_title=J Mater Sci Mater Med; citation_title=Doxorubicin eluting beads–1: effects of drug loading on bead characteristics and drug distribution; citation_author=AL Lewis, MV Gonzalez, SW Leppard; citation_volume=18; citation_publication_date=2007; citation_pages=1691-1699; citation_doi=10.1007/s10856-007-3068-8; citation_id=CR18
citation_journal_title=Radiology; citation_title=Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization; citation_author=JW Chung, JH Park, JK Han; citation_volume=198; citation_publication_date=1996; citation_pages=33-40; citation_doi=10.1148/radiology.198.1.8539401; citation_id=CR19
citation_journal_title=J Vasc Interv Radiol; citation_title=Determinants of postembolization syndrome after hepatic chemoembolization; citation_author=DA Leung, JE Goin, C Sickles; citation_volume=12; citation_publication_date=2001; citation_pages=321-326; citation_doi=10.1016/S1051-0443(07)61911-3; citation_id=CR20
citation_journal_title=Jpn J Clin Oncol; citation_title=Measuring response in solid tumors: comparison of RECIST and WHO response criteria; citation_author=OP Joon, SI Lee, SY Song; citation_volume=33; citation_publication_date=2003; citation_pages=533-537; citation_doi=10.1093/jjco/hyg093; citation_id=CR21
citation_journal_title=J Hepatol; citation_title=Maximum number of target lesions required to measure responses to transarterial chemoembolization using the enhancement criteria in patients with intrahepatic hepatocellular carcinoma; citation_author=H Shim, H Lee, H Won; citation_volume=56; citation_issue=2; citation_publication_date=2012; citation_pages=406-11; citation_doi=10.1016/j.jhep.2011.04.028; citation_id=CR22
citation_journal_title=J Vasc Interv Radiol; citation_title=Chemoembolization of liver tumor in a rabbit model: assessment of tumor cell death with diffusion- weighted MR imaging and histologic analysis; citation_author=JF Geschwind, D Artemov, S Abraham; citation_volume=11; citation_publication_date=2000; citation_pages=1245-1255; citation_doi=10.1016/S1051-0443(07)61299-8; citation_id=CR23
citation_journal_title=Jpn J Clin Oncol; citation_title=Prognostic factors in patients with hepatocellular carcinoma treated by transcatheter arterial embolization; citation_author=M Ikeda, S Okada, S Yamamoto; citation_volume=32; citation_publication_date=2002; citation_pages=455-460; citation_doi=10.1093/jjco/hyf097; citation_id=CR24
citation_journal_title=Cancer; citation_title=A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization; citation_author=L Llado, J Virgili, J Figueras; citation_volume=88; citation_publication_date=2000; citation_pages=50-57; citation_doi=10.1002/(SICI)1097-0142(20000101)88:1<50::AID-CNCR8>3.0.CO;2-I; citation_id=CR25
citation_journal_title=Med Oncol; citation_title=Transarterial chemoembolization compared with conservative treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus: using a new classification; citation_author=ZJ Niu, YL Ma, P Kang; citation_volume=29; citation_issue=4; citation_publication_date=2012; citation_pages=2992-7; citation_doi=10.1007/s12032-011-0145-0; citation_id=CR26
citation_journal_title=J Exp Clin Cancer Res; citation_title=Trans-arterial chemo-embolization (TACE), with either lipiodol (traditional TACE) or drug-eluting microspheres (precision TACE, pTACE) in the treatment of hepatocellular carcinoma: efficacy and safety results from a large mono-institutional analysis; citation_author=M Scartozzi, GS Baroni, L Faloppi; citation_volume=29; citation_publication_date=2010; citation_pages=164; citation_doi=10.1186/1756-9966-29-164; citation_id=CR27
citation_journal_title=Cancer Imaging; citation_title=Trans-arterial chemoembolization and external beam radiation therapy for treatment of hepatocellular carcinoma with a tumor thrombus in the inferior vena cava and right atrium; citation_author=F Duan, W Yu, Y Wang; citation_volume=15; citation_publication_date=2015; citation_pages=7; citation_doi=10.1186/s40644-015-0043-3; citation_id=CR28