Journal of Liver Cancer

Original Article

Conventional versus Drug-eluting Beads Trans-arterial Chemoembolization for Treatment of Hepatocellular Carcinoma at Very Early and Early Stages: Kwang-Hun Lee, Seung-Moon Joo, Tae Jun Yum, Sang Hoon Jung; J Liver Cancer. 2017;17(2):144-152. Published online September 30, 2017; DOI: https://doi.org/10.17998/jlc.17.2.144

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Background/Aims
To retrospectively compare conventional and drug-eluting beads transarterial chemoembolization (C-TACE and DEB-TACE) for treatment of hepatocellular carcinoma (HCC) at very early and early stages.
Methods
We retrospectively compared patients treated with C-TACE (n=115) or DEB-TACE (n=103) from September 2009 to May 2016. All patients were in a very early (stage 0) or early stage (stage A) of the Barcelona Clinic Liver Cancer (BCLC) staging system, and all had Child– Pugh class A and ≤B7 liver status. Approval by the institutional review board was waived because the study was retrospective. The following parameters were evaluated: severe pain and bradycardia during TACE, post-embolization syndrome (PES), liver function change, complications, target tumor response, and conversion to another treatment modality. Numeric differences were assessed by the independent Student’s t-test for continuous variables and by chi-square test for categorical variables.
Results
Severe intractable pain and bradycardia during the TACE procedure were significantly more frequent in the C-TACE group than in the DEB-TACE group (P<0.001). The incidence and duration of PES were significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The increase in liver enzymes was significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The deterioration of the Child-Pugh class was significantly higher in the C-TACE group than in the DEB-TACE group (P =0.006). There was no significant difference in serious complications except localized bile duct dilatation between the groups. There was no significant difference between the groups in tumor response at both immediate and 1-year assessment. The conversion rate to other treatment modalities was significantly higher in the DEB-TACE group than in the C-TACE group (P<0.001).
Conclusions
DEB-TACE is better than C-TACE in terms of procedural safety as initial treatment in a very early or early stage of HCC.

Citations

Citations to this article as recorded by

Superselective ablative chemo-ethanol embolization for recurrent single hepatocellular carcinoma: a 6-month outcome analysis
Jae Hwan Lee, Kun Yung Kim, Chong-ho Lee, Minuk Kim, Chang Jin Yoon
Journal of Liver Cancer.2024; 24(2): 217. CrossRef
Drug-Eluting Bead Transarterial Chemoembolization Versus Radiofrequency Ablation as an Initial Treatment of Single Small (≤ 3 cm) Hepatocellular Carcinoma
Somin Lee, Yong Yeon Jeong, Byung Chan Lee, Sang Soo Shin, Suk Hee Heo, Hyoung Ook Kim, Chan Park, Won Gi Jeong
Journal of Korean Medical Science.2023;[Epub] CrossRef
Current status of transarterial chemoembolization (TACE) agents in hepatocellular carcinoma treatment
Roshana Saghafian Larijani, Nazanin Shabani Ravari, Navid Goodarzi, Shahram Akhlaghpour, Samaneh Saghafian Larijani, Mohammad Reza Rouini, Rassoul Dinarvand
Journal of Drug Delivery Science and Technology.2022; 77: 103905. CrossRef
Transarterial chemoembolization using drug-eluting bead compared with radiofrequency ablation for treatment of single small hepatocellular carcinoma: a pilot non-randomized trial
Tae Hoon Kim, Na Hye Kim, Jin Dong Kim, Young Nam Kim, Yu Jin Kim, Eun Jung Kim, Ki Deok Yoo, Choong Heon Ryu, Ha Hun Song, Hyun Kim
Journal of Liver Cancer.2021; 21(2): 146. CrossRef

Review Article

Transarterial Chemoembolization with Drug-Eluting Beads for Hepatocellular Carcinoma: Myeong Jun Song; Journal of the Korean Liver Cancer Study Group. 2012;12(2):88-92. Published online September 30, 2012

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Abstract PDF: Transarterial chemoembolization (TACE) has been widely used as a standard treatment for HCC patients who are not suitable candidates for curative treatments and as a bridge to liver transplantation. The rationale for TACE is that the intra-arterial chemotherapy using lipiodol and chemotherapeutic agents, followed by selective vascular embolization, will result in a strong cytotoxic effect combined with ischemia (conventional TACE). Recently, drug-eluting beads (DC Bead®) for the transcatheter treatment of HCC have been developed to deliver higher doses of chemotherapeutic agent and to prolong contact time with the tumor. DC Bead® has the ability to actively sequester doxorubicin hydrochloride from solution and release it in a controlled and sustained fashion. Treatment with DC Bead® has been shown to substantially diminish the amount of chemotherapeutic agent that reaches the systemic circulation compared with conventional, lipiodol-based regimens, significantly reducing drug-related adverse events. In this article, we describe the treatment efficacy and safety of TACE with the drug-eluting bead for the treatment of hepatocellular carcinoma and discuss future therapeutic possibilities.

Case Reports

A Case of Combination Therapy Using Radioembolization and Transarterial Chemoembolization with Drug-eluting Beads in Bilobar Hepatocellular Carcinomas: Hee Yeon Kim, Chung-Hwa Park, Do Seon Song, Myeong Jun Song, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Ho Jung Chun; Journal of the Korean Liver Cancer Study Group. 2012;12(2):128-132. Published online September 30, 2012

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Abstract PDF: Bilobar multifocal hepatocellular carcinomas (HCCs) can be treated with transarterial radioembolization in a sequential lobar, or whole liver manner. However, radioembolization could result in a risk of radiation-induced liver toxicity in patients with reduced functional reserve. Here we describe a case with bilobar HCCs successfully treated with a combination therapy using radioembolization and transarterial chemoembolization with drug-eluting beads without significant side effects. A 72-year-old female with liver cirrhosis was diagnosed of hepatocellular carcinoma with bilobar involvement. The main mass in the left lobe was treated with radioembolization while the other lesion in the right lobe was treated with transarterial chemoembolization using drug-eluting beads, and the patient was tolerable. A combination of radioembolization and selective transarterial chemoem- bolization may be considered for an alternative option in patients with bilobar multifocal HCCs with decreased liver function.

A Case of Hepatocellular Carcinoma which Showed Response to Transarterial Chemoembolization with DC Bead® in the Patient who Showed No Response to Conventional Transarterial Chemoembolization: Do Seon Song, Hee Yeon Kim, Myeong Jun Song, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Ho Jong Chun; Journal of the Korean Liver Cancer Study Group. 2012;12(2):133-136. Published online September 30, 2012

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Abstract PDF: Hepatocellular carcinoma (HCC) is one of the most important cause of cancer death in South Korea. Approximately two thirds of the HCC patients are diagnosed in the unresectable stage. Conventional transarterial chemoembolization (TACE) showed survival benefit in the unresectable HCC patients, but it had some limitations, such as low response rate and systemic toxicity. Drug eluting bead has been reported low systemic toxicity and higher tumor necrosis rate. We report a case which showed response to TACE with DC bead in patient that showed no response to conventional TACE.

A Case of Atypicial Finding on Follow-up CT after TACE with Doxorubicin-eluting-beads (DEB): Jang Won Park, Gang Mo Kim; Journal of the Korean Liver Cancer Study Group. 2012;12(2):164-168. Published online September 30, 2012

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Abstract PDF: Hepatocellular carcinoma is the sixth most common cancer and the third leading cause of cancer-ralated death. TACE is an effective option for patients with intermediate HCC. Although conventional TACE with administration of a Lipiodo-anticancer emulsion followed by embolic agents has been most popular technique, the recent introduction of embolic DEB has provided a valuable alternative. The DEB is a novel drug delivery embolization system that hea been designed to deliver a higher and more sustained release of drug directly into the tumor and a low release of drug into the systemic circulation, with the intention to maximize the drug effectiveness in terms of response, while significantly reducing its systemic toxicity. Obtaining a triple-phase CT or MRI imaging of the liver is required to integrate clinical and laboratory data to evaluate the indication to TACE with DEB and additional imaging to exclude extrahepatic disease should be performed as pretreatment imaging. Obtaining a CT or MRI imaging 2-4 weeks after TACE is recommend to assess tumor response and to decide the further plan. The use of modified Response Evaluation Criteria in Solid Tumors (mRECIST) for HCC is recommended for response Classification. We offer our experience of a patient with atypical finindg on follow-up CT after DEB TACE. Marginal recurrence or residual viable tumor was suspected on CT 4 weeks after DEB TACE but disappeared on CT 10 weeks after treatment. There was no evidence of recurrence or residual tumor in TACE site and its margin 12 weeks after TACE. We thought that it was attributed to the benign change as AV shunt or to the characteristics of DEB which has been designed to deliver slowly, higher and more sustained release of drug directly into the tumor. But further study is necessary on how long the drug delivery from DEB to tumor is sustained and when the appropriate tumor response is accomplished after treatment.

A Case of Aggressive Treatment with Transarterial Embolization Using Drug-Eluting Beads for Hepatocellular Carcinoma in Decompensated Liver Cirrhosis Patient: Eileen L. Yoon, Hyung Joon Yim, Hwan Hoon Chung, Seung Hwa Lee, Hae Rim Kim, Jong Jin Hyun, Sung Woo Jung, Ja Seol Koo, Sang Woo Lee, Jai Hyun Choi; Journal of the Korean Liver Cancer Study Group. 2011;11(2):190-194. Published online September 30, 2011

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Abstract PDF: Conventional transarterical chemoembolization (TACE) is the first-line treatment for patients with intermediate stage of hepatocellular carcinoma (HCC). However, irreversible liver failure after the procedure is one of the most feared complications and therefore, decompensated Child-Pugh C patients may not be the indication of the conventional TACE. Drug-eluting beads loaded with doxorubicin is a novel drug delivery embolization system and reported to have non inferior efficacy compared to conventional TACE. Also drug-eluting beads loaded with doxorubicin is associated with lower rates of acute liver failure after the procedure and lower rates of systemic toxicity of the chemotherapeutic agents. Herein, we report a case of aggressive treatment with transarterial embolization using drug-eluting beads loaded with doxorubicin for HCC in decompensated liver cirrhosis patient who was not eligible for conventional TACE treatment.

Review Article

A Review on Embolic Materials for Transcatheter Arterial Chemoembolization: Byung Kook Kwak, Hyung Jin Shim; Journal of the Korean Liver Cancer Study Group. 2011;11(1):1-5. Published online February 28, 2011

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Abstract PDF: Four procedures on intraarterial catheter-based therapy are available in treating hepatocellular carcinoma: intraarterial chemotherapy (IAC), transcatheter arterial embolization (TAE), conventional transcatheter arterial chemoembolization (cTACE), and transcatheter arterial chemoembolization using drug-eluting bead (DEB-TACE). On the bases of “2009 Practice Guideline for Diagnosis and Treatment of Hepatocellular Carcinoma” by The Korean Liver Cancer Study Group and National Cancer Center, and “2010 AASLD Practice Guideline” by American Association for the Study of Liver Disease, substances and recommendations on interventional managements were reviewed. Various kinds of embolic materials used in the procedures of TAE, cTACE and DEB-TACE were described in detail.

Case Report

Hepatocellular Carcinoma Diagnosed with Metastatic Lesion of the Cervical Spine: Chung-Hwa Park, Myeong Jun Song, Hee Yeon Kim, Si Hyun Bae, Seung Kew Yoon, Jong Young Choi; Journal of the Korean Liver Cancer Study Group. 2010;10(1):61-63. Published online June 30, 2010

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Abstract PDF: Bone metastases in hepatocellular carcinoma (HCC) are usually treated with non-operative procedures such as radiotherapy, hormonal therapy, bisphosphonates, or sometimes with surgical procedures. Here we describe a case with 3rd cervical spine metastasis of HCC. A 62-year-old female with liver cirrhosis presented with neck pain. After evaluation, the patient was diagnosed of hepatocellular carcinoma with cervical spine metastasis. The metastatic lesion was treated with tomotherapy while the primary lesion in the liver was treated with transarterial chemoembolization using drug-eluting beads, and the patient is tolerable waiting for the next treatment.

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