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Conventional versus Doxorubicin-Eluting Beads Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma: a Tertiary Medical Centre Experience in Malaysia

  • Rahman, F Abdul (Gastroenterology Unit, Department of Medicine, Universiti Sains Islam Malaysia) ;
  • Naidu, J (Gastroenterology Unit, Department of Medicine, Universiti Sains Islam Malaysia) ;
  • Ngiu, CS (Gastroenterology Unit, Department of Medicine, Universiti Sains Islam Malaysia) ;
  • Yaakob, Y (Endovascular and Interventional Unit, Department of Radiology, Universiti Sains Islam Malaysia) ;
  • Mohamed, Z (Endovascular and Interventional Unit, Department of Radiology, Universiti Sains Islam Malaysia) ;
  • Othman, H (Hepatobiliary Unit, Department of Surgery, Universiti Sains Islam Malaysia) ;
  • Jarmin, R (Hepatobiliary Unit, Department of Surgery, Universiti Sains Islam Malaysia) ;
  • Elias, MH (Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Universiti Sains Islam Malaysia) ;
  • Hamid, N Abdul (Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Universiti Sains Islam Malaysia) ;
  • Mokhtar, N Mohd (Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Universiti Sains Islam Malaysia) ;
  • Ali, RA Raja (Gastroenterology Unit, Department of Medicine, Universiti Sains Islam Malaysia)
  • 발행 : 2016.08.01

초록

Background: Hepatocellular carcinoma (HCC) is a common cancer that is frequently diagnosed at an advanced stage. Transarterial chemoembolisation (TACE) is an effective palliative treatment for patients who are not eligible for curative treatment. The two main methods for performing TACE are conventional (c-TACE) or with drug eluting beads (DEB-TACE). We sought to compare survival rates and tumour response between patients undergoing c-TACE and DEB-TACE at our centre. Materials and Methods: A retrospective cohort study of patients undergoing either treatment was carried out from January 2009 to December 2014. Tumour response to the procedures was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Kaplan-Meier analysis was used to assess and compare the overall survival in the two groups. Results: A total of 79 patients were analysed (34 had c-TACE, 45 had DEB-TACE) with a median follow-up of 11.8 months. A total of 20 patients in the c-TACE group (80%) and 12 patients in the DEB-TACE group (44%) died during the follow up period. The median survival durations in the c-TACE and DEB-TACE groups were $4.9{\pm}3.2$ months and $8.3{\pm}2.0$ months respectively (p=0.008). There was no statistically significant difference noted among the two groups with respect to mRECIST criteria. Conclusions: DEB-TACE demonstrated a significant improvement in overall survival rates for patients with unresectable HCC when compared to c-TACE. It is a safe and promising approach and should potentially be considered as a standard of care in the management of unresectable HCC.

키워드

참고문헌

  1. Arabi M, BenMousa A, Bzeizi K, et al (2015). Doxorubicinloaded drug-eluting beads versus conventional transarterial chemoembolization for nonresectable hepatocellular carcinoma. Saudi J Gastroenterol, 21, 175-80 https://doi.org/10.4103/1319-3767.157571
  2. Au JS, Frenette CT (2015). Management of Hepatocellular Carcinoma: Current Status and Future Directions. Gut Liver, 9, 437-48 https://doi.org/10.5009/gnl15022
  3. Borzio M, Dionigi E, Parisi G, et al (2015). Management of hepatocellular carcinoma in the elderly. World J Hepatol, 7, 1521-9 https://doi.org/10.4254/wjh.v7.i11.1521
  4. Boulin M, Delhom E, Pierredon-Foulongne MA, et al (2015). Transarterial chemoembolization for hepatocellular carcinoma: An old method, now flavor of the day. Diagn Interv Imaging, 96, 607-15. https://doi.org/10.1016/j.diii.2015.04.005
  5. Brown DB, Geschwind JF, Soulen MC, et al (2006). Society of Interventional Radiology position statement on chemoembolization of hepatic malignancies. J Vasc Interv Radiol, 17, 217-23 https://doi.org/10.1097/01.RVI.0000196277.76812.A3
  6. Bruix J, Sherman M, Llovet JM, et al (2001). Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol, 35, 421-30. https://doi.org/10.1016/S0168-8278(01)00130-1
  7. Chen KW, Ou TM, Hsu CW, et al (2015). Current systemic treatment of hepatocellular carcinoma: A review of the literature. World J Hepatol, 7, 1412-20 https://doi.org/10.4254/wjh.v7.i10.1412
  8. Ciria R, Lopez-Cillero P, Gallardo AB, et al (2015). Optimizing the management of patients with BCLC stage-B hepatocellular carcinoma: Modern surgical resection as a feasible alternative to transarterial chemoemolization. Eur J Surg Oncol, 41, 1153-61 https://doi.org/10.1016/j.ejso.2015.05.023
  9. Di Costanzo GG, Tortora R (2015). Intermediate hepatocellular carcinoma: How to choose the best treatment modality? World J Hepatol, 7, 1184-91. https://doi.org/10.4254/wjh.v7.i9.1184
  10. El-Serag HB (2012). Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterol, 142, 1264-73. https://doi.org/10.1053/j.gastro.2011.12.061
  11. Kawahara D, Ozawa S, Hioki K, et al (2015). SU-D-BRB-07: Lipiodol Impact On Dose Distribution in Liver SBRT After TACE. Med Phys, 42, 3212.
  12. Kudo M (2015). Surveillance, diagnosis, treatment, and outcome of liver cancer in Japan. Liver Cancer, 4, 39-50. https://doi.org/10.1159/000367727
  13. Kew MC (2010). Epidemiology of chronic hepatitis B virus infection, hepatocellular carcinoma, and hepatitis B virusinduced hepatocellular carcinoma. Pathol Biol (Paris), 58, 273-7 https://doi.org/10.1016/j.patbio.2010.01.005
  14. Lafaro KJ, Demirjian AN, Pawlik TM (2015). Epidemiology of hepatocellular carcinoma. Surg Oncol Clin N Am, 24, 1-17. https://doi.org/10.1016/j.soc.2014.09.001
  15. Lammer J, Malagari K, Vogl T, et al (2010). Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol, 33, 41-52. https://doi.org/10.1007/s00270-009-9711-7
  16. Lencioni R, de Baere T, Burrel M, et al (2012). Transcatheter treatment of hepatocellular carcinoma with Doxorubicinloaded DC Bead (DEBDOX): technical recommendations. Cardiovasc Intervent Radiol, 35, 980-5. https://doi.org/10.1007/s00270-011-0287-7
  17. Lencioni R, Llovet JM (2010). Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis, 30, 52-60. https://doi.org/10.1055/s-0030-1247132
  18. Lo CM, Ngan H, Tso WK, et al (2002). Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatol, 35, 1164-71. https://doi.org/10.1053/jhep.2002.33156
  19. Llovet JM, Real MI, Montana X, et al (2002). Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet, 359, 1734-9. https://doi.org/10.1016/S0140-6736(02)08649-X
  20. Meza-Junco J, Montano-Loza AJ, Liu DM, et al (2012). Locoregional radiological treatment for hepatocellular carcinoma; Which, when and how? Cancer Treat Rev, 38, 54-62. https://doi.org/10.1016/j.ctrv.2011.05.002
  21. Pascual S, Herrera I, Irurzun J (2016). New advances in hepatocellular carcinoma. World J Hepatol, 8, 421-38. https://doi.org/10.4254/wjh.v8.i9.421
  22. Sasaki Y (2015). Progress of Regional Therapy for Hepatocellular Carcinoma. Gan To Kagaku Ryoho, 42, 771-7.
  23. Schultheiss M, Bettinger D, Neeff HP, et al (2015). Hepatocellular Carcinoma: therapeutic options 2015. Dtsch Med Wochenschr, 140, 1063-8. https://doi.org/10.1055/s-0041-102333
  24. Sherman M (2010). Epidemiology of hepatocellular carcinoma. Oncol, 78, 7-10. https://doi.org/10.1159/000315223
  25. Song MJ, Park CH, Kim JD, et al (2011). Drug-eluting bead loaded with doxorubicin versus conventional Lipiodolbased transarterial chemoembolization in the treatment of hepatocellular carcinoma: a case-control study of Asian patients. Eur J Gastroenterol Hepatol, 23, 521-7. https://doi.org/10.1097/MEG.0b013e328346d505
  26. Torre LA, Bray F, Siegel RL, et al (2015). Global cancer statistics, 2012. CA Cancer J Clin, 65, 87-108. https://doi.org/10.3322/caac.21262
  27. Vincenzi B, Di Maio M, Silletta M, et al (2015). Prognostic Relevance of Objective Response According to EASL Criteria and mRECIST Criteria in Hepatocellular Carcinoma Patients Treated with Loco-Regional Therapies: A Literature- Based Meta-Analysis. PLoS One, 10, 133488.
  28. Wang DY, Liu L, Qi XS, et al (2015). Hepatic re-resection versus transarterial chemoembolization for the treatment of recurrent hepatocellular carcinoma after initial resection: a systematic review and meta-analysis. Asian Pac J Cancer Prev, 16, 5573-8. https://doi.org/10.7314/APJCP.2015.16.13.5573
  29. Yang XD, Pan LH, Wang L, et al (2015). Systematic review of single large and/or multinodular hepatocellular carcinoma: surgical resection improves survival. Asian Pac J Cancer Prev, 16, 5541-7 https://doi.org/10.7314/APJCP.2015.16.13.5541
  30. Zu QQ, Liu S, Zhou CG, et al (2015). Chemoembolization of recurrent hepatoma after curative resection: prognostic factors. Am J Roentgenol, 204, 1322-8. https://doi.org/10.2214/AJR.14.13343