Initial Transarterial Chemoembolization (TACE) Using HepaSpheres 20-40 µm and Subsequent Lipiodol TACE in Patients with Hepatocellular Carcinoma > 5 cm

Clinical outcomes of modified transarterial chemoembolization vs. drug-eluting bead transarterial chemoembolization as initial treatment for single hepatocellular carcinoma: a propensity score matching analysis

BACKGROUND & AIMS

Optimizing transarterial chemoembolization (TACE) can enhance treatment efficacy for hepatocellular carcinoma (HCC). This study compares modified TACE (M-TACE), which combines a lipiodol-based emulsion and drug-eluting beads, with drug-eluting bead TACE (DEB-TACE) as initial therapies for solitary HCC.

METHODS

In this retrospective study, 185 patients undergoing M-TACE or DEB-TACE were evaluated. Propensity score matching was used to create 69 balanced pairs. Initial tumor response, repeated treatments within six months, local tumor progression (LTP), overall survival (OS), and adverse events (AEs) were assessed.

RESULTS

M-TACE exhibited significantly higher initial complete response (CR) rates (39.1% vs. 23.2%, p = 0.043) and fewer repeated treatments within six months (1.7 ± 0.9 vs. 2.1 ± 0.7; p = 0.033) compared to DEB-TACE. LTP rates were notably lower with M-TACE at 12 months (39.1% vs. 65.2%, p = 0.002), and median time to LTP was prolonged with M-TACE (13.3 vs. 8.2 months, p = 0.038). Stratified analysis revealed a significantly longer OS in individuals achieving a CR after the initial M-TACE (50.5 vs. 33.4 months, p = 0.043). However, the overall study population did not exhibit a significant difference in OS between the two groups. Comparable AEs (all p > 0.05) were observed.

CONCLUSIONS

M-TACE showed higher initial CR rates, lower LTP rates, and extended time to LTP compared to DEB-TACE, indicating its potential to enhance TACE effectiveness for solitary HCC.

Chemoembolization versus Radiotherapy for Single Hepatocellular Carcinomas of ≤3 cm Unsuitable for Image-Guided Tumor Ablation

BACKGROUND/AIMS

Local ablation therapy (LAT) is primarily recommended for solitary inoperable hepatocellular carcinomas (HCCs) of ≤3 cm in diameter. However, only two-thirds of uninodular small HCCs are suitable for LAT, and the second-best treatment option for managing these nodules is unclear. We aimed to compare the therapeutic outcomes of chemoembolization and radiotherapy in small HCCs unsuitable for LAT.

METHODS

The study included 651 patients from a tertiary referral center who underwent planning sonography for LAT. These patients had 801 solitary HCCs of ≤3 cm in diameter and were treated with LAT, chemoembolization, or radiotherapy. Local tumor progression (LTP)-free survival and overall survival (OS) were measured according to the type of treatment of the index nodule.

RESULTS

LAT, chemoembolization, and radiotherapy were used to treat 561, 185, and 55 nodules in 467, 148, and 36 patients, respectively. LTP-free survival was significantly shorter in patients treated with chemoembolization than for those treated with LAT (multivariate hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.61 to 3.47) but not for those treated with radiotherapy (HR, 0.83; 95% CI, 0.38 to 1.83). However, OS was not affected by treatment modality. Matching and weighting analyses confirmed that radiotherapy gave comparable results to chemoembolization in terms of OS despite better LTP-free survival (HR, 2.91; 95% CI, 1.13 to 7.47 and HR, 3.07; 95% CI, 1.11 to 8.48, respectively).

CONCLUSIONS

Our data suggest that chemoembolization and radiotherapy are equally effective options for single small HCCs found to be unsuitable for LAT after sonographic planning. Betterfit indications for each procedure should be established by specifically designed studies.