Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of Chemoembolization Outcomes Using 70-150 ㎛ and 100-300 ㎛ Drug-Eluting Beads in Treating Small Hepatocellular Carcinoma: A Korean Multicenter Study

  • Byung Chan Lee (Department of Radiology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital) ;
  • Gyoung Min Kim (Department of Radiology, Severance Hospital, Yonsei University College of Medicine) ;
  • Juil Park (Department of Radiology, Severance Hospital, Yonsei University College of Medicine) ;
  • Jin Wook Chung (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital) ;
  • Jin Woo Choi (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital) ;
  • Ho Jong Chun (Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Jung Suk Oh (Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Dong Ho Hyun (Department of Radiology, Samsung Medical Center, Sungkyunkwan University College of Medicine) ;
  • Jung Ho Yang (Department of Preventive Medicine, Chonnam National University Medical School, Chonnam National University Hospital Cardio-Cerebrovascular Center)
  • Received : 2024.05.07
  • Accepted : 2024.06.25
  • Published : 2024.08.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: To evaluate the outcomes of drug-eluting bead transarterial chemoembolization (DEB-TACE) according to the size of the beads for the treatment of small hepatocellular carcinoma (HCC). Materials and Methods: This retrospective study included 212 patients with a single HCC ≤5 cm from five tertiary institutions. One hundred and nine patients were treated with 70-150-㎛ doxorubicin DEBs (group A), and 103 patients received 100-300-㎛ doxorubicin DEBs (group B). The initial tumor response (assessed between 3 weeks and 2 months after DEB-TACE), time to local tumor progression (TTLTP), restricted mean duration of complete response (RMDCR), rate of complications, incidence of post-embolization syndrome, and length of hospital stay were compared between the two groups. Logistic regression was used to analyze prognostic factors for initial tumor response. Results: The initial objective response rates were 91.7% (100/109) and 84.5% (87/103) for groups A and B, respectively (P = 0.101). In the subgroup analysis of tumors ≤3 cm, the initial objective response rates were 94.6% (53/56) and 78.0% (39/50) for groups A and B, respectively (P = 0.012). There was no significant difference in the TTLTP (median, 23.7 months for group A vs. 19.0 months for group B; P = 0.278 [log-rank], 0.190 [multivariable Cox regression]) or RMDCR at 24 months (11.4 months vs. 8.5 months, respectively; P = 0.088). In the subgroup analysis of tumors >3-cm, the RMDCR at 24 months was significantly longer in group A than in group B (11.8 months vs. 5.7 months, P = 0.024). The incidence of mild bile duct dilatation after DEB-TACE was significantly higher in group B than in group A (5.5% [6/109] vs. 18.4% [19/103], P = 0.003). Conclusion: DEB-TACE using 70-150-㎛ microspheres demonstrated a higher initial objective response rate in ≤3-cm HCCs and a longer RMDCR at 24 months in 3.1-5-cm HCCs compared to larger DEBs (100-300-㎛).

Keywords

Acknowledgement

The Terumo Research Fund (2021) through the Korean Society of Interventional Radiology.

References

  1. Reig M, Forner A, Rimola J, Ferrer-Fabrega J, Burrel M, Garcia-Criado A, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol 2022;76:681-693 https://doi.org/10.1016/j.jhep.2021.11.018
  2. Varela M, Real MI, Burrel M, Forner A, Sala M, Brunet M, et al. Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 2007;46:474-481 https://doi.org/10.1016/j.jhep.2006.10.020
  3. Sacco R, Bargellini I, Bertini M, Bozzi E, Romano A, Petruzzi P, et al. Conventional versus doxorubicin-eluting bead transarterial chemoembolization for hepatocellular carcinoma. J Vasc Interv Radiol 2011;22:1545-1552 https://doi.org/10.1016/j.jvir.2011.07.002
  4. Golfieri R, Giampalma E, Renzulli M, Cioni R, Bargellini I, Bartolozzi C, et al. Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. Br J Cancer 2014;111:255-264 https://doi.org/10.1038/bjc.2014.199
  5. Lee KH, Liapi E, Vossen JA, Buijs M, Ventura VP, Georgiades C, et al. Distribution of iron oxide-containing Embosphere particles after transcatheter arterial embolization in an animal model of liver cancer: evaluation with MR imaging and implication for therapy. J Vasc Interv Radiol 2008;19:1490-1496 https://doi.org/10.1016/j.jvir.2008.06.008
  6. Dreher MR, Sharma KV, Woods DL, Reddy G, Tang Y, Pritchard WF, et al. Radiopaque drug-eluting beads for transcatheter embolotherapy: experimental study of drug penetration and coverage in swine. J Vasc Interv Radiol 2012;23:257-264.e4 https://doi.org/10.1016/j.jvir.2011.10.019
  7. Malagari K. Drug-eluting particles in the treatment of HCC: chemoembolization with doxorubicin-loaded DC Bead. Expert Rev Anticancer Ther 2008;8:1643-1650 https://doi.org/10.1586/14737140.8.10.1643
  8. Padia SA, Shivaram G, Bastawrous S, Bhargava P, Vo NJ, Vaidya S, et al. Safety and efficacy of drug-eluting bead chemoembolization for hepatocellular carcinoma: comparison of small-versus medium-size particles. J Vasc Interv Radiol 2013;24:301-306 https://doi.org/10.1016/j.jvir.2012.11.023
  9. Prajapati HJ, Xing M, Spivey JR, Hanish SI, El-Rayes BF, Kauh JS, et al. Survival, efficacy, and safety of small versus large doxorubicin drug-eluting beads TACE chemoembolization in patients with unresectable HCC. AJR Am J Roentgenol 2014;203:W706-W714 https://doi.org/10.2214/AJR.13.12308
  10. Lee M, Chung JW, Lee KH, Won JY, Chun HJ, Lee HC, et al. Korean multicenter registry of transcatheter arterial chemoembolization with drug-eluting embolic agents for nodular hepatocellular carcinomas: six-month outcome analysis. J Vasc Interv Radiol 2017;28:502-512 https://doi.org/10.1016/j.jvir.2016.08.017
  11. Ikeda M, Arai Y, Inaba Y, Tanaka T, Sugawara S, Kodama Y, et al. Conventional or drug-eluting beads? Randomized controlled study of chemoembolization for hepatocellular carcinoma: JIVROSG-1302. Liver Cancer 2022;11:440-450 https://doi.org/10.1159/000525500
  12. Lee IJ, Lee JH, Lee YB, Kim YJ, Yoon JH, Yin YH, et al. Effectiveness of drug-eluting bead transarterial chemoembolization versus conventional transarterial chemoembolization for small hepatocellular carcinoma in Child-Pugh class A patients. Ther Adv Med Oncol 2019;11:1758835919866072
  13. Irie T, Kuramochi M, Takahashi N. Diameter of main tumor feeding artery of a hepatocellular carcinoma: measurement at the entry site into the nodule. Hepatol Res 2016;46:E100-E104 https://doi.org/10.1111/hepr.12534
  14. Deipolyi AR, Oklu R, Al-Ansari S, Zhu AX, Goyal L, Ganguli S. Safety and efficacy of 70-150 ㎛ and 100-300 ㎛ drug-eluting bead transarterial chemoembolization for hepatocellular carcinoma. J Vasc Interv Radiol 2015;26:516-522 https://doi.org/10.1016/j.jvir.2014.12.020
  15. Huo YR, Xiang H, Chan MV, Chan C. Survival, tumour response and safety of 70-150 ㎛ versus 100-300 ㎛ doxorubicin drug-eluting beads in transarterial chemoembolization for hepatocellular carcinoma. J Med Imaging Radiat Oncol 2019;63:802-811 https://doi.org/10.1111/1754-9485.12971
  16. Yi JW, Hong HP, Kim MS, Shin BS, Kwon HJ, Kim BI, et al. Comparison of clinical efficacy and safety between 70-150 ㎛ and 100-300 ㎛ doxorubicin drug-eluting bead transarterial chemoembolization for hepatocellular carcinoma. Life (Basel) 2022;12:297
  17. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2018;68:723-750 https://doi.org/10.1002/hep.29913
  18. Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2017;65:310-335 https://doi.org/10.1002/hep.28906
  19. Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea. 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Korean J Radiol 2022;23:1126-1240 https://doi.org/10.3348/kjr.2022.0822
  20. Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010;30:52-60 https://doi.org/10.1055/s-0030-1247132
  21. Delgado A, Guddati AK. Clinical endpoints in oncology - a primer. Am J Cancer Res 2021;11:1121-1131
  22. Huang B, Tian L. Utilizing restricted mean duration of response for efficacy evaluation of cancer treatments. Pharm Stat 2022;21:865-878 https://doi.org/10.1002/pst.2198
  23. Huang B, Tian L, McCaw ZR, Luo X, Talukder E, Rothenberg M, et al. Analysis of response data for assessing treatment effects in comparative clinical studies. Ann Intern Med 2020;173:368-374 https://doi.org/10.7326/M20-0104
  24. Gaba RC, Lewandowski RJ, Hickey R, Baerlocher MO, Cohen EI, Dariushnia SR, et al. Transcatheter therapy for hepatic malignancy: standardization of terminology and reporting criteria. J Vasc Interv Radiol 2016;27:457-473 https://doi.org/10.1016/j.jvir.2015.12.752
  25. Leung DA, Goin JE, Sickles C, Raskay BJ, Soulen MC. Determinants of postembolization syndrome after hepatic chemoembolization. J Vasc Interv Radiol 2001;12:321-326 https://doi.org/10.1016/S1051-0443(07)61911-3
  26. Lee SY, Ou HY, Yu CY, Huang TL, Tsang LL, Cheng YF. Drug-eluting bead transarterial chemoembolization for hepatocellular carcinoma: does size really matter? Diagn Interv Radiol 2020;26:230-235 https://doi.org/10.5152/dir.2019.19261
  27. Lee M, Chung JW, Lee KH, Won JY, Chun HJ, Lee HC, et al. Prospective multi-center Korean registry of transcatheter arterial chemoembolization with drug-eluting embolics for nodular hepatocellular carcinoma: a two-year outcome analysis. Korean J Radiol 2021;22:1658-1670 https://doi.org/10.3348/kjr.2020.1117
  28. Matsui O, Kobayashi S, Sanada J, Kouda W, Ryu Y, Kozaka K, et al. Hepatocelluar nodules in liver cirrhosis: hemodynamic evaluation (angiography-assisted CT) with special reference to multi-step hepatocarcinogenesis. Abdom Imaging 2011;36:264-272 https://doi.org/10.1007/s00261-011-9685-1
  29. Bargellini I, Bozzi E, Campani D, Carrai P, De Simone P, Pollina L, et al. Modified RECIST to assess tumor response after transarterial chemoembolization of hepatocellular carcinoma: CT-pathologic correlation in 178 liver explants. Eur J Radiol 2013;82:e212-e218 https://doi.org/10.1016/j.ejrad.2012.12.009
  30. Dioguardi Burgio M, Ronot M, Bruno O, Francoz C, Paradis V, Castera L, et al. Correlation of tumor response on computed tomography with pathological necrosis in hepatocellular carcinoma treated by chemoembolization before liver transplantation. Liver Transpl 2016;22:1491-1500 https://doi.org/10.1002/lt.24615
  31. Aliberti C, Carandina R, Lonardi S, Dadduzio V, Vitale A, Gringeri E, et al. Transarterial chemoembolization with small drug-eluting beads in patients with hepatocellular carcinoma: experience from a cohort of 421 patients at an Italian center. J Vasc Interv Radiol 2017;28:1495-1502 https://doi.org/10.1016/j.jvir.2017.07.020
  32. Odisio BC, Ashton A, Yan Y, Wei W, Kaseb A, Wallace MJ, et al. Transarterial hepatic chemoembolization with 70-150 ㎛ drug-eluting beads: assessment of clinical safety and liver toxicity profile. J Vasc Interv Radiol 2015;26:965-971 https://doi.org/10.1016/j.jvir.2015.03.020
  33. Malagari K, Iezzi R, Goldberg SN, Bilbao JI, Sami A, Akhan O, et al. The ten commandments of chemoembolization: expert discussion and report from Mediterranean Interventional Oncology (MIOLive) congress 2017. Eur Rev Med Pharmacol Sci 2018;22:372-381
  34. Han K, Jung I. Restricted mean survival time for survival analysis: a quick guide for clinical researchers. Korean J Radiol 2022;23:495-499 https://doi.org/10.3348/kjr.2022.0061