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Transarterial Chemoembolization of Child-A hepatocellular carcinoma: drug-eluting bead TACE (DEB TACE) vs. TACE with cisplatin/lipiodol (cTACE).

Wiggermann P, Sieron D, Brosche C, Brauer T, Scheer F, Platzek I, Wawrzynek W, Stroszczynski C - Med. Sci. Monit. (2011)

Bottom Line: The choice of TACE procedure (DEB TACE/cTACE) had no significant impact on therapy-associated complications.After DEB-TACE mean survival was significantly prolonged with 651 ± 76 days vs. 414 ± 43 days for cTACE (p=0.01).Associated with a similar safety profile and an at least comparable tumour response, the DEB-TACE is a method of treatment for HCC that has the potential to improve mean survival compared to cTACE with Cisplatin/Lipiodol.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Dresden University of Technology, Dresden, Germany. openphw@googlemail.com

ABSTRACT

Background: This study is an outcome evaluation of the Drug-Eluting-Bead-Chemoembolization (DEB TACE) compared to conventional TACE (cTACE) with Cisplation and Lipiodol in patients with hepatocellular carcinoma (HCC) and Child-Pugh A Cirrhosis.

Material/methods: A comparison of interventional therapy with either cTACE or DEB-TACE of 22 patients each with unresectable HCC and Child-Pugh A Cirrhosis was carried out. A comparison of therapy-associated complications, tumour response rates and mean survival was performed. Tumour response was evaluated in accordance with the European Association for the Study of the Liver (EASL) response criteria by two radiologists in consensus reading.

Results: The choice of TACE procedure (DEB TACE/cTACE) had no significant impact on therapy-associated complications. Objective Response (OR, complete response + partial response) for DEB-TACE was 22.7%; a further 68.2% was stable disease (SD). The respective response rates for the cTACE were OR 22.7 and SD 31.8%. Thus disease control was not significantly increased for DEB TACE (p=0.066). After DEB-TACE mean survival was significantly prolonged with 651 ± 76 days vs. 414 ± 43 days for cTACE (p=0.01).

Conclusions: Associated with a similar safety profile and an at least comparable tumour response, the DEB-TACE is a method of treatment for HCC that has the potential to improve mean survival compared to cTACE with Cisplatin/Lipiodol.

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Related in: MedlinePlus

(A) Selective catheterization of feeding arteries of an HCC. The use of a micro catheter facilitates administration of the embolic agent selectively to the tumour, sparing adjacent liver parenchyma. (B) Postembolization image shows complete occlusion of the tumour vessels.
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f2-medscimonit-17-4-cr189: (A) Selective catheterization of feeding arteries of an HCC. The use of a micro catheter facilitates administration of the embolic agent selectively to the tumour, sparing adjacent liver parenchyma. (B) Postembolization image shows complete occlusion of the tumour vessels.

Mentions: A transfemoral access was chosen in all cases. After local anaesthesia of the skin and subcutaneous tissue (10–20 ml prilocaine hydrochloride), a 5F standard catheter was placed through a 5F introducer in the initial treatment session. Angiography of the upper abdominal vessels was performed first to determine the arterial supply of the liver by means of automated injection of contrast agent. Apart from selective imaging of the coeliac trunk, the superior mesenteric artery was examined separately in order to rule out normal variants of the hepatic blood supply. In the event of a normal supply, the common hepatic artery was cannulated over a hydrophilic guide wire and the catheter was placed in the right or left hepatic artery according to the tumour location. Superselective embolization only of the segmental or subsegmental arteries supplying the tumour was performed by means of a microcatheter (Progreat 2.7 F; Terumo or Tracker 2,4 F; Boston Scientific). In cTACE an emulsion consisting of 20 mg cisplatin and 20 ml lipiodol followed by particle embolization (Contour SE; Boston Scientific) was delivered at each session. In DEB-TACE 50 mg epirubicin coupled with 2 ml DC Beads (1 vial of 300–500 μm DC Beads) was given at each session. Particle embolization (Contour SE; Boston Scientific) was performed in addition where necessary. The treatment was concluded after stasis or reflux occurred in the corresponding vascular segment (second- or third-order branches of the right or left hepatic artery) (Figure 2). The patients were admitted to a ward for monitoring and were discharged the next day if asymptomatic. Nausea, pain or fever subsequently were treated symptomatically depending on their severity, e.g. with Navoban 5–15 mg i.v., analgesics (e.g. Metamizole i. v. or drops) and antipyretic agents (e.g. Paracetamol tablets 500–1000 mg).


Transarterial Chemoembolization of Child-A hepatocellular carcinoma: drug-eluting bead TACE (DEB TACE) vs. TACE with cisplatin/lipiodol (cTACE).

Wiggermann P, Sieron D, Brosche C, Brauer T, Scheer F, Platzek I, Wawrzynek W, Stroszczynski C - Med. Sci. Monit. (2011)

(A) Selective catheterization of feeding arteries of an HCC. The use of a micro catheter facilitates administration of the embolic agent selectively to the tumour, sparing adjacent liver parenchyma. (B) Postembolization image shows complete occlusion of the tumour vessels.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539521&req=5

f2-medscimonit-17-4-cr189: (A) Selective catheterization of feeding arteries of an HCC. The use of a micro catheter facilitates administration of the embolic agent selectively to the tumour, sparing adjacent liver parenchyma. (B) Postembolization image shows complete occlusion of the tumour vessels.
Mentions: A transfemoral access was chosen in all cases. After local anaesthesia of the skin and subcutaneous tissue (10–20 ml prilocaine hydrochloride), a 5F standard catheter was placed through a 5F introducer in the initial treatment session. Angiography of the upper abdominal vessels was performed first to determine the arterial supply of the liver by means of automated injection of contrast agent. Apart from selective imaging of the coeliac trunk, the superior mesenteric artery was examined separately in order to rule out normal variants of the hepatic blood supply. In the event of a normal supply, the common hepatic artery was cannulated over a hydrophilic guide wire and the catheter was placed in the right or left hepatic artery according to the tumour location. Superselective embolization only of the segmental or subsegmental arteries supplying the tumour was performed by means of a microcatheter (Progreat 2.7 F; Terumo or Tracker 2,4 F; Boston Scientific). In cTACE an emulsion consisting of 20 mg cisplatin and 20 ml lipiodol followed by particle embolization (Contour SE; Boston Scientific) was delivered at each session. In DEB-TACE 50 mg epirubicin coupled with 2 ml DC Beads (1 vial of 300–500 μm DC Beads) was given at each session. Particle embolization (Contour SE; Boston Scientific) was performed in addition where necessary. The treatment was concluded after stasis or reflux occurred in the corresponding vascular segment (second- or third-order branches of the right or left hepatic artery) (Figure 2). The patients were admitted to a ward for monitoring and were discharged the next day if asymptomatic. Nausea, pain or fever subsequently were treated symptomatically depending on their severity, e.g. with Navoban 5–15 mg i.v., analgesics (e.g. Metamizole i. v. or drops) and antipyretic agents (e.g. Paracetamol tablets 500–1000 mg).

Bottom Line: The choice of TACE procedure (DEB TACE/cTACE) had no significant impact on therapy-associated complications.After DEB-TACE mean survival was significantly prolonged with 651 ± 76 days vs. 414 ± 43 days for cTACE (p=0.01).Associated with a similar safety profile and an at least comparable tumour response, the DEB-TACE is a method of treatment for HCC that has the potential to improve mean survival compared to cTACE with Cisplatin/Lipiodol.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Dresden University of Technology, Dresden, Germany. openphw@googlemail.com

ABSTRACT

Background: This study is an outcome evaluation of the Drug-Eluting-Bead-Chemoembolization (DEB TACE) compared to conventional TACE (cTACE) with Cisplation and Lipiodol in patients with hepatocellular carcinoma (HCC) and Child-Pugh A Cirrhosis.

Material/methods: A comparison of interventional therapy with either cTACE or DEB-TACE of 22 patients each with unresectable HCC and Child-Pugh A Cirrhosis was carried out. A comparison of therapy-associated complications, tumour response rates and mean survival was performed. Tumour response was evaluated in accordance with the European Association for the Study of the Liver (EASL) response criteria by two radiologists in consensus reading.

Results: The choice of TACE procedure (DEB TACE/cTACE) had no significant impact on therapy-associated complications. Objective Response (OR, complete response + partial response) for DEB-TACE was 22.7%; a further 68.2% was stable disease (SD). The respective response rates for the cTACE were OR 22.7 and SD 31.8%. Thus disease control was not significantly increased for DEB TACE (p=0.066). After DEB-TACE mean survival was significantly prolonged with 651 ± 76 days vs. 414 ± 43 days for cTACE (p=0.01).

Conclusions: Associated with a similar safety profile and an at least comparable tumour response, the DEB-TACE is a method of treatment for HCC that has the potential to improve mean survival compared to cTACE with Cisplatin/Lipiodol.

Show MeSH
Related in: MedlinePlus