Bicarbonate-integrated transarterial chemoembolization (TACE) in real-world hepatocellular carcinoma

The objective response rate of conventional transarterial chemoembolization (TACE) for locoregional control of hepatocellular carcinoma (HCC) is approximately 50%. We previously developed bicarbonate-integrated TACE, termed TILA-TACE, which demonstrated 100% effectiveness for locoregional control of unresectable HCC. This study aimed to validate its efficacy, selectivity, and safety in real-world clinical practice (ChiCTR-ONC-17013416). A total of 413 patients were enrolled, including 40 (9.7%) with early-stage HCC, 29 (7.0%) with intermediate-stage HCC, and 344 (83.3%) with advanced-stage HCC. Primary tumors and macrovascular invasion/extrahepatic metastases were treated with TILA-TACE and radiation therapy, respectively. The side effects of TILA-TACE were recorded. The objective response rate of HCC tumors to TILA-TACE was 99.01%, including a complete response in 72.77% of patients. The objective response rate of tumor thrombus to radiation therapy was 96.88%. During a median follow-up of 38 months, there were 1 and 4 deaths among early- and intermediate-stage patients, respectively. The median survival of advanced-stage patients was 27 months. We found that intrahepatic metastases accounted for 70.4% (107/152) of cancer-related deaths after effective control of primary tumors and vascular invasion. The main adverse events associated with TILA-TACE were transient liver enzyme or bilirubin abnormalities (86.44% and 56.66%, respectively), which was consistent with the known side-effect profile of TACE. In conclusion, TILA-TACE is a novel and highly effective treatment for the local control of HCC with a tolerable safety profile. When combined with radiation therapy for macrovascular invasion, it offers significant survival benefits for patients with advanced HCC.