Nine-year experience of doxorubicin-eluting beads chemoembolization for hepatocellular carcinoma
Alvin Ho-Kwan Cheung1, Colin Siu-Chi Lam, Henry Shiu-Cheung Tam
1Department of Surgery, University of Hong Kong and Queen Mary Hospital, 102 Pok Fu Lam Rd, Pok Fu Lam, Hong Kong, China. cheung_hokwan@hotmail.com.
Insights
Doxorubicin-eluting beads (DEB) chemoembolization offers superior efficacy and tumor response compared to conventional TACE for hepatocellular carcinoma (HCC) treatment. This method shows a greater decrease in AFP levels and improved objective response rates, suggesting better therapeutic outcomes.
Area of Science:
- Hepatobiliary oncology
- Interventional radiology
- Cancer therapy
Background:
- Hepatocellular carcinoma (HCC) is a primary liver cancer.
- Chemoembolization is a standard treatment for HCC.
- Doxorubicin-eluting beads (DEB) chemoembolization has been used since 2007.
Purpose of the Study:
- To compare the efficacy and survival outcomes of DEB chemoembolization versus conventional TACE (cTACE) in HCC patients.
- To evaluate tumor response and overall survival rates between the two treatment modalities.
Main Methods:
- Retrospective case-control study design.
- Comparison of overall survival and tumor response in HCC patients treated with cTACE (n=190) and DEB (n=143).
- Assessment via computed tomography, serum alpha-fetoprotein (AFP) levels, and multivariate analysis.
Main Results:
- DEB treatment resulted in a significantly greater decrease in post-treatment to pre-treatment AFP levels compared to cTACE (0.8 vs 1.0, P<0.05).
- Higher objective tumor response rates were observed in the DEB group across different time points (0-3 months, 3-6 months, 6-12 months).
- DEB significantly increased the odds of achieving objective tumor response (3.604 times, P<0.0001) and showed a trend towards improved median survival (12.53 months vs 10.53 months).
Conclusions:
- DEB chemoembolization demonstrates superior therapeutic efficacy compared to cTACE for HCC.
- DEB is a safe and effective alternative treatment for hepatocellular carcinoma.
- DEB offers improved tumor response and a tendency for enhanced survival in HCC patients.
Background:
Chemoembolization with doxorubucin-eluting beads (DEB) has been used to treat hepatocellular carcinoma (HCC) since 2007. This study compared the efficacy and survival between transarterial chemoembolization (TACE) with DEB and conventional approach (cTACE) in HCC treatment.
Methods:
This retrospective case-control study compared the overall survival and tumor response of HCC patients to cTACE (n=190) and DEB (n=143) by the reassessment of computed tomography and serum alpha-fetoprotein (AFP). Multivariate analysis was used to determine the factors affecting tumor response.
Results:
The median post-treatment to pre-treatment AFP level was 0.8 for a DEB session (n=258) and 1.0 for a cTACE session (n=452), showing a significantly greater decrease in AFP after DEB (P<0.05). More patients in the DEB group achieved objective response (complete and partial) compared with those in the cTACE group (P<0.05). Objective tumor response after DEB vs cTACE was 34.8% vs 15.4% in 0-3 months (P=0.001), 37.1% vs 20.0% in 3-6 months (P<0.05), and 50.0% vs 30.0% in 6-12 months (P=0.093). DEB predicted a 3.604 times odds of achieving at least one objective tumor response in a patient when compared to cTACE (P<0.0001). The median survival from first transcatheter therapy of patients having undergone at least once DEB was 12.53 months, while those having received cTACE only was 10.53 months (P=0.086). A tendency of improved survival appeared to maintain until >80 months after the first TACE session in the DEB group.
Conclusion:
DEB is a safe alternative to cTACE in HCC patients with better therapeutic efficacy.
