Super-selective transarterial chemoembolization of hepatocellular carcinoma with doxorubicin-eluting beads sized 40–75 microns: assessment of efficacy and safety

PURPOSEWe aimed to evaluate the effectiveness and safety of super-selective transarterial chemoembolization (TACE) with doxorubicin-loaded drug-eluting beads (DEB) sized 40–75 μm for hepatocellular carcinoma (HCC) in early and intermediate stages according to Barcelona Clinic Liver Cancer (BCLC) staging system.METHODSThis single-center retrospective study was conducted with 45 consecutive HCC patients treated by 72 sessions of DEB-TACE during the 2012–2017 period. Thirty-seven patients (82.2%) had single tumor staged BCLC A and B (53.3% and 46.7%, respectively). All procedures were performed by super-selective approach using 1.7–2.0 F microcatheters. Cone beam CT was performed to detect all tumor-feeding arteries and assess the treatment results immediately. Dynamic MRI and laboratory tests were obtained at 1-month follow-up and every 3 months thereafter. Response to treatment according to modified Response Evaluation Criteria in Solid Tumors, demographic and clinical status, laboratory tests, time-to-event durations and rates, complications according to the National Cancer Institute Criteria for Adverse Events were evaluated.RESULTSA total of 45 patients (median age, 65.6 years; range, 35–88 years; 33 men, 73.4%) were included. Eight patients (17.7%) underwent liver transplantation after DEB-TACE, and 20 (44.4%) died during the follow-up period. Median follow-up was 22 months (range, 13–31), and 42 (93.3%) patients were followed up for more than 1 year. Overall complete response, partial response, and progressive disease rates were 53.3%, 33.3%, and 13.4% at one year and 22.2%, 26.7%, and 13.3% at three years, respectively. For target lesions, these rates were 60.0%, 26.7%, and 13.3% at one year and 28.9%, 6.7%, and 4.4% at three years, respectively. Median overall survival (OS) duration was 24 months (95% CI, 20.9–31.9 months). At one year and three years, OS rates were 71.0% and 44.4%, respectively. The only statistically significant relationship with OS was presence of chronic liver disease, which worsened the OS rate (P = 0.031). Time-to-progression (TTP) was 23 months (95% CI, 15.1–40.0), and progression-free survival (PFS) was 28 months (95% CI, 6.2–39.8). Post-embolization syndrome occurred in 10 patients (22.2%). Transient grade I/II bilirubin and aminotransferase elevation was observed in 26 (57.7%) and 18 (40%) patients, respectively.CONCLUSIONSuper-selective DEB-TACE with doxorubicin-loaded beads sized 40–75 μm is an effective and safe treatment method with prolonged TTP and PFS in early and intermediate stages of HCC. Presence of chronic liver disease is the only significant factor that worsened OS ratios after DEB-TACE