Should we routinely use DEBTACE for unresectable HCC? cTACE versus DEBTACE: a single-center survival analysis
M Massani1,2, T Stecca3, C Ruffolo3
1IV Department Of Surgery, Regional Center for HPB Surgery, Ca' Foncello Regional Hospital, 31100, Treviso, Italy. mmassani@ulss.tv.it.
Insights
Drug-eluting-beads-TACE (DEBTACE) and conventional trans-arterial chemoembolization (cTACE) show similar survival outcomes for intermediate/advanced hepatocellular carcinoma (HCC). DEBTACE appears better tolerated, with patient liver function being the primary determinant of survival.
Area of Science:
- Hepatobiliary Medicine
- Interventional Radiology
- Oncology
Background:
- Hepatocellular carcinoma (HCC) is a significant global health concern, often treated with trans-arterial chemoembolization (TACE).
- Conventional TACE (cTACE) offers survival benefits but can have limitations.
- Drug-eluting-beads TACE (DEBTACE) has emerged as an alternative aiming for improved efficacy and tolerability.
Purpose of the Study:
- To retrospectively compare the effectiveness and safety of cTACE versus DEBTACE in patients with intermediate/advanced HCC.
- To evaluate overall survival (OS) as the primary endpoint.
- To identify factors influencing survival in HCC patients undergoing TACE.
Main Methods:
- Retrospective analysis of 82 non-surgical HCC patients treated between 2006 and 2012.
- Patients received either cTACE or DEBTACE with a standard chemotherapy dose.
- Overall survival, radiological response (CT scan at 30 days), and procedural complications were assessed.
Main Results:
- Median survival was comparable: 22.7 months for DEBTACE vs. 21.8 months for cTACE (p=0.708).
- No significant difference in survival was observed between the two TACE techniques.
- Child-Pugh score was the sole significant predictor of survival, with Child A being protective (OR 0.583).
Conclusions:
- DEBTACE and cTACE demonstrate comparable overall survival for intermediate/advanced HCC.
- DEBTACE may offer better tolerability compared to cTACE.
- Patient's reserved liver function, specifically Child-Pugh score, is the most critical factor influencing survival outcomes.
Abstract:
Conventional trans-arterial chemoembolization (cTACE) for intermediate stage hepatocellular carcinoma (HCC) achieves a partial response in up to 72% of patients and improves median survival. Drug-eluting-beads-TACE (DEBTACE) improves treatment efficacy and tolerance as compared to cTACE. Our aim was to retrospectively evaluate our experience in the treatment of intermediate/advanced HCC with cTACE versus DEBTACE. Overall survival (OS) was the first endpoint. We retrospectively considered our department register data between 2006 and 2012. A total of 82 non-surgical patients, who underwent cTACE or DEBTACE, with a minimum of 12 months follow-up, met the inclusion criteria. Patients received a standard chemotherapy dose (50 mg). Radiological response was evaluated by CT after 30 days and re-treatment was considered. Statistical analysis was performed with SPSS software. 54 patients received cTACE and 28 DEBTACE. In the DEBTACE group the median survival times was 22.7 months (CI 11.6-33.8), while in the cTACE group it was 21.8 months (CI 15.7-27.9). The survival analysis at log-rank (p = 0.708) and Wilcoxon (p = 0.661) tests demonstrated no differences between DEBTACE and cTACE. The probability of death in function of time was significantly associated only to the Child-Pugh score. A Child A score was shown to be protective instead of Child B (OR 0.583; IC 95% = 0.344-0.987). DEBTACE for treating HCC is comparable to cTACE in terms of effectiveness, but seems to be better tolerated. Both treatments can be performed in case of tumor recurrence without substantial increase in procedural complications and risk of liver failure. We do confirm that there are no differences between the two techniques in terms of survival and that it is mainly affected by the reserved liver function proper of each patient.
