Midterm follow-up after DC-BEAD™-TACE of hepatocellular carcinoma (HCC)
Marijke Skowasch1, Jens Schneider, Gerd Otto
1Department of Diagnostic and Interventional Radiology, Johannes Gutenberg University of Mainz, Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany. marijkeskowasch@aol.com
Aim:
To determine local response, its predictors and survival and complication rates after DC-Bead™-TACE in patients with hepatocellular carcinoma (HCC).
Materials And Methods:
DC-Beads™ are non-resorbable, polyvinyl-alcoholic hydrophilic microspheres. They release high amounts of chemotherapeutics directly into the tumour. Delivery is sustained over time, tumour feeders are embolised. We used beads from 100-300 to 500-700 μm loaded with Doxorubicin (max. 150 mg/4ml). Fifty patients (mean age: 68.5 ± 8.8 years) with HCC were analysed. DC-Bead™-TACE was performed once or repeated in two-month intervals. Imaging scans (CT or MRI) were done one-month following each procedure. To evaluate tumour response EASL and RECIST criteria was applied. If eligible, every patient received a non-selective TACE.
Results:
128 DC-Bead™ sessions were performed: 127 showed technical success, 120 successful stasis. Complications occurred in 7% (9/128): active bleeding into the tumour (n=1), liver failure (n=1), liver abscess (n=1) ascites (n=3), pleural effusion (n=1), false aneurysm (n=1) and hypoglycaemia (n=1). At imaging after the 1st, 2nd, 3rd and 4th-8th session, objective response (complete+partial) was 49%, 67%, 67% and 31%, progressive disease was seen in n=11/50. Baseline diameter and differentiation significantly impacted response. Median overall survival was 25.1 months (95% [CI]: 18.3-31.9) with an estimated cumulative survival rate at one and two-to-four years of 66.7% and 45.7%, respectively.
Conclusion:
DC-Beads™ can be safely and effectively control HCC. Survival and response rates are encouraging, complications are low. Many factors are involved in response to treatment like liver function or child state.
