Response rate and clinical outcome of HCC after first and repeated cTACE performed "on demand"
E Terzi1, R Golfieri, F Piscaglia
1BLOG-Bologna Liver Oncology Group, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Insights
Conventional transarterial chemoembolization (cTACE) shows similar response and recurrence rates for initial and repeated treatments in HCC patients. This "on demand" approach may inform future treatment strategy trials.
Area of Science:
- Hepatology
- Interventional Radiology
- Oncology
Background:
- Hepatocellular carcinoma (HCC) management often involves transarterial chemoembolization.
- The efficacy of repeated conventional transarterial chemoembolization (cTACE) on demand requires further clinical assessment.
- Understanding recurrence and survival outcomes is crucial for optimizing HCC treatment strategies.
Purpose of the Study:
- To evaluate the clinical impact of on-demand repeated conventional transarterial chemoembolization (cTACE) on hepatocellular carcinoma (HCC) outcomes.
- To assess response rates, recurrence rates, and overall survival following cTACE.
- To provide data for planning future clinical trials comparing repeated cTACE with other treatment modalities.
Main Methods:
- Retrospective analysis of 151 consecutive HCC patients undergoing initial cTACE between January 2004 and December 2005.
- Evaluation of outcomes including response rate, recurrence, and overall survival after first, second, and third cTACE.
- Multivariate analysis to identify factors associated with overall survival.
Main Results:
- Complete radiological response (CR) rates were 48% after the first cTACE, 52% after the second, and 55% after the third.
- Recurrence rates at 6 and 12 months were similar after the first and second cTACE (37%/61% and 40%/59%, respectively).
- Median overall survival was 32.0 months (25.0 months excluding transplanted patients); higher bilirubin, higher AFP, and failure to achieve CR were associated with shorter survival.
Conclusions:
- On-demand repeated cTACE demonstrated comparable CR and recurrence rates to initial cTACE.
- Approximately 64% of patients received a second cTACE, while only 26% received a third, highlighting the "on demand" application.
- These findings support the planning of trials evaluating repeated TACE against adjuvant or systemic therapies for HCC.
Background & Aims:
Aim of the study was to assess the clinical impact of conventional transarterial chemoembolization (cTACE) repeated "on demand" on HCC outcome. Outcome measures were: response rate to first and repeated cTACE, recurrence rates and overall survival.
Methods:
The outcome of 151 consecutive HCC patients submitted to a first cTACE from January 2004 to December 2005 was retrospectively analyzed.
Results:
Complete radiological response (CR) was observed in 72/151 (48%), 34/60 (52%) and 12/22 (55%) patients after first, second and third cTACE, respectively. Recurrence rates at 6 and 12months were 37% and 61% after the first cTACE, and 40% and 59% after the second cTACE, respectively. Patients not achieving CR or with a recurrence after CR not treated with curative therapies were 94 and 84 after first and second cTACE, respectively. Of these, 60/94 (64%) and 22/84 (26%) were submitted to a second and third cTACE, respectively. Median overall survival was 32.0months but 25.0months excluding transplanted patients. Factors at the time of first cTACE associated with overall shorter survival at multivariate analysis were higher bilirubin, higher AFP and not achieving CR.
Conclusions:
CR and recurrence rates after first and second cTACE were similar. About 64% of patients were submitted to second cTACE, while only few patients (26%) were submitted to third cTACE using an "on demand" policy. These figures may be also useful for planning trials for the evaluation of the efficacy of repeated TACE vs. TACE combined with adjuvant treatments or vs. systemic treatments.
