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Trans-arterial Chemo-Embolization in Treating Elderly Patients with Hepatocellular Carcinoma

  • Zhang, Jian-Feng (The Second People's Hospital of Nanjing) ;
  • Liu, Jun-Mao (The Second People's Hospital of Nanjing) ;
  • Zhang, Nin (The Second People's Hospital of Nanjing) ;
  • Du, Chao (The Second People's Hospital of Nanjing) ;
  • Zheng, Qin (The Second People's Hospital of Nanjing)
  • Published : 2015.11.04

Abstract

Background: This analysis was conducted to evaluate the efficacy and safety of Trans-arterial Chemo-Embolization (TACE) in treating Elderly patients with Hepatocellular Carcinoma (EHPC). Methods: Clinical studies evaluating the efficacy and safety of TACE on response and safety for patients with EHPC were identified by using a predefined search strategy. Pooled response rate of treatment were calculated. Results: In TACE based regimen, clinical studies which including patients with EHPC were considered eligible for the evaluation of response. And, in these TACE based treatments, pooled analysis suggested that, in all 288 patients whose response could be assessed, the pooled reponse rate was 29.5%(85/288) in TACE based treatment. The most commonly encountered TACE-related morbidity was liver function impairment. No grade III or IV renal or liver toxicity were observed. No treatment related death occurred in EHPC patients with TACE based treatments. Conclusion: This evidence based analysis suggests that TACE based treatments are associated with mild response rate and accepted toxicities for treating patients with EHPC.

Keywords

TACE;elderly patients with Hepatocellular Carcinoma

References

  1. Biselli M, Forti P, Mucci F, et al (1997). Chemoembolization versus chemotherapy in elderly patients with unresectable hepatocellular carcinoma and contrast uptake as prognostic factor. J Gerontol A Biol Sci Med Sci, 52, 305-9.
  2. Bruix J, Sherman M (2005). Management of hepatocellular carcinoma. Hepatology, 42, 1208-36. https://doi.org/10.1002/hep.20933
  3. Bruix J, Sherman M (2011). Management of hepatocellular carcinoma: an update. Hepatology, 53, 1020-2. https://doi.org/10.1002/hep.24199
  4. Bruix J, Castells A, Montanya X, et al (1994). Phase II study of transarterial embolization in European patients with hepatocellular carcinoma: need for controlled trials. Hepatology, 20, 643-50. https://doi.org/10.1002/hep.1840200315
  5. Carr BI, Zajko A, Bron K, et al (1997). Phase II study of Spherex (degradable starch microspheres) injected into the hepatic artery in conjunction with doxorubicin and cisplatin in the treatment of advanced-stage hepatocellular carcinoma: interim analysis. Semin Oncol, 24, 97-9.
  6. Camma C, Schepis F, Orlando A, et al (2002). Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology, 224, 47-54. https://doi.org/10.1148/radiol.2241011262
  7. Cho SJ, Yoon JH, Hwang SS, et al (2007). Do young hepatocellular carcinoma patients with relatively good liver function have poorer outcomes than elderly patients? J Gastroenterol Hepatol, 22, 1226-31. https://doi.org/10.1111/j.1440-1746.2007.04914.x
  8. Chuang VP, Wallace S, Soo CS, et al (1982). Terapeutic Ivalon embolization of hepatic tumors. AJR Am J Roentgenol, 138, 289-94. https://doi.org/10.2214/ajr.138.2.289
  9. Cohen MJ, Bloom AI, Barak O, et al (2013). Trans-arterial chemo-embolization is safe and effective for very elderly patients with hepatocellular carcinoma. World J Gastroenterol, 19, 2521-8. https://doi.org/10.3748/wjg.v19.i16.2521
  10. Cohen MJ, Levy I, Barak O, et al (2014). Trans-arterial chemo-embolization is safe and effective for elderly advanced hepatocellular carcinoma patients: results from an international database. Liver Int, 34, 1109-17. https://doi.org/10.1111/liv.12486
  11. Collier JD, Curless R, Bassendine MF, et al (1994). Clinical features and prognosis of hepatocellular carcinoma in Britain in relation to age. Age Ageing, 23, 22-7. https://doi.org/10.1093/ageing/23.1.22
  12. Dhanasekaran R, Kooby DA, Staley CA, et al (2010). Comparison of conventional transarterial chemoembolization (TACE) and chemoembolization with doxorubicin drug eluting beads (DEB) for unresectable hepatocelluar carcinoma (HCC). J Surg Oncol, 101, 476-80.
  13. Dohmen K, Shirahama M, Shigematsu H, et al (2004). Optimal treatment strategy for elderly patients with hepatocellular carcinoma. J Gastroenterol Hepatol, 19, 859-65. https://doi.org/10.1111/j.1440-1746.2003.03306.x
  14. Earle CC, Venditti LN, Neumann PJ, et al (2000). Who gets chemotherapy for metastatic lung cancer? Chest, 117, 1239-46. https://doi.org/10.1378/chest.117.5.1239
  15. European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer (2012). EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol, 56, 908-43. https://doi.org/10.1016/j.jhep.2011.12.001
  16. Fernandez-Ruiz M, Guerra-Vales JM, Llenas-Garcia J, et al (2008). Hepatocellular carcinoma in the elderly: clinical characteristics, survival analysis, and prognostic indicators in a cohort of Spanish patients older than 75 years. Rev Esp Enferm Dig, 100, 625-31.
  17. Gunji T, Kawauchi N, Ohnishi S, et al (1992). Treatment of hepatocellular carcinoma associated with advanced cirrhosis by transcatheter arterial chemoembolization using autologous blood clot: a preliminary report. Hepatology, 15, 252-7. https://doi.org/10.1002/hep.1840150213
  18. Hoshida Y, Ikeda K, Saito S, et al (1999). The efficacy and prognosis of transcatheter chemoembolization for hepatocellular carcinoma in the elderly. Nihon Shokakibyo Gakkai Zasshi, 96, 142-6.
  19. Huang J, Li BK, Chen GH, et al (2009). Long-term outcomes and prognostic factors of elderly patients with hepatocellular carcinoma undergoing hepatectomy. J Gastrointest Surg, 13, 1627-35. https://doi.org/10.1007/s11605-009-0933-4
  20. Hutchins LF, Unger JM, Crowley JJ, et al (1999). Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med, 341, 2061-7. https://doi.org/10.1056/NEJM199912303412706
  21. Kumar V, Fausto N, Abbas A (editors) (2003). Robbins & Cotran Pathologic Basis of Disease (7th ed.). Saunders. pp. 914-7.
  22. 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
  23. Lee CR, Lim JH, Kim SH, et al (2012). A comparative analysis of hepatocellular carcinoma after hepatic resection in young versus elderly patients. J Gastrointest Surg, 16, 736-43.
  24. Lewandowski RJ, Kulik LM, Riaz A, et al (2009). A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant, 9, 1920-8. https://doi.org/10.1111/j.1600-6143.2009.02695.x
  25. Llovet JM, Bruix J (2003). Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology, 37, 429-42. https://doi.org/10.1053/jhep.2003.50047
  26. Makuuchi M, Kokudo N, Arii S, et al (2008). Development of evidence-based clinical guidelines for the diagnosis and treatment of hepatocellular carcinoma in Japan. Hepatol Res, 38, 37-51. https://doi.org/10.1111/j.1872-034X.2007.00216.x
  27. Mirici-Cappa F, Gramenzi A, Santi V, et al (2010). Treatments for hepatocellular carcinoma in elderly patients are as effective as in younger patients: a 20-year multicentre experience. Gut, 59, 387-96. https://doi.org/10.1136/gut.2009.194217
  28. Nicolini A, Martinetti L, Crespi S, et al (2010). Transarterial chemoembolization with epirubicin-eluting beads versus transarterial embolization before liver transplantation for hepatocellular carcinoma. J Vasc Interv Radiol, 21, 327-32. https://doi.org/10.1016/j.jvir.2009.10.038
  29. Nishikawa H, Kita R, Kimura T, et al (2014). Transcatheter arterial chemoembolization for intermediate-stage hepatocellular carcinoma: clinical outcome and safety in elderly patients. J Cancer, 17, 590-7.
  30. Omata M, Lesmana LA, Tateishi R, et al (2010). Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int, 4, 439-74. https://doi.org/10.1007/s12072-010-9165-7
  31. Oishi K, Itamoto T, Kobayashi T, et al (2009). Hepatectomy for hepatocellular carcinoma in elderly patients aged 75 years or more. J Gastrointest Surg, 13, 695-701. https://doi.org/10.1007/s11605-008-0758-6
  32. Pignata S, Gallo C, Daniele B, et al (2006). Characteristics at presentation and outcome of hepatocellular carcinoma (HCC) in the elderly. A study of the Cancer of the Liver Italian Program (CLIP). Crit Rev Oncol Hematol, 59, 243-9. https://doi.org/10.1016/j.critrevonc.2006.01.002
  33. Portolani N, Baiocchi GL, Coniglio A, et al (2011). Limited liver resection: a good indication for the treatment of hepatocellular carcinoma in elderly patients. Jpn J Clin Oncol, 41, 1358-65. https://doi.org/10.1093/jjco/hyr154
  34. Seeff LB, Hoofnagle JH (2006). Epidemiology of hepatocellular carcinoma in areas of low hepatitis B and hepatitis C endemicity. Oncogene, 25, 3771-7. https://doi.org/10.1038/sj.onc.1209560
  35. Thuluvath PJ, Guidinger MK, Fung JJ, et al (2010). Liver transplantation in the United States, 1999-2008. Am J Trans Plant, 2, 1003-19.
  36. Tsukioka G, Kakizaki S, Sohara N, et al (2006). Hepatocellular carcinoma in extremely elderly patients: an analysis of clinical characteristics, prognosis and patient survival. World J Gastroenterol, 12, 48-53. https://doi.org/10.3748/wjg.v12.i1.48