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Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma
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Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Radiobiology and Nuclear Medicine".

Deadline for manuscript submissions: closed (31 August 2021) | Viewed by 13711

Special Issue Editor

Dr. Jin Hyoung Kim

E-Mail Website
Guest Editor
Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Interests: liver cancer; hepatocellular carcinoma; transarterial chemoembolization; radiofrequency ablation; stent

Special Issue Information

Dear Colleagues,

Primary liver cancer is the fourth most common cause of cancer-associated death worldwide, with hepatocellular carcinoma (HCC) accounting for 90% of primary liver cancers.

Hepatic resection and liver transplantation offer curative treatment; however, most patients with HCC (70%–80%) are not candidates for these curative surgeries due to either an advanced stage at the time of initial presentation or underlying liver cirrhosis.

Transarterial chemoembolization (TACE) is a widely used treatment that has been used for many years to delay tumor progression in patients with incurable HCCs. As HCC is predominantly supplied by the hepatic artery, TACE is an attractive option for the treatment of HCC because chemoagent or embolic materials can be efficiently delivered. TACE is currently considered the standard of care for intermediate-stage HCC. Furthermore, with the development of TACE devices and techniques, patient survival has gradually increased while TACE-related mortality has decreased year by year.

However, TACE is not infrequently used, even in patients with early stage or advanced-stage HCC in real clinical practice. Furthermore, recent combinations of TACE and ablation therapies showed survival outcomes comparable to surgical resection in certain patients with early stage HCC. In advanced-stage HCC, recent randomized controlled trials and retrospective studies found that TACE plus radiotherapy or TACE plus systemic therapy (tyrosine kinase inhibitors or immunotherapy) provides a promising clinical outcome.

Thus, it may be important to define the role of TACE and to find certain patient groups that will benefit from TACE in the treatment of HCC.

Dr. Jin Hyoung Kim
Guest Editor

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Keywords

  • hepatocellular carcinoma
  • transarterial chemoembolization
  • drug-eluting microsphere TACE
  • balloon-occluded TACE
  • radiotherapy
  • tyrosine kinase inhibitors
  • immunotherapy

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Published Papers (5 papers)

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Research

13 pages, 2032 KiB  
Article
Sorafenib Combined with Chemoembolization for Locally Advanced Hepatocellular Carcinoma with Macroscopic Vascular Invasion: A Propensity Score Analysis
by Gun Ha Kim, Sang Lim Choi, Jin Hyoung Kim, Ju Hyun Shim, Meshari Alali and Nayoung Kim
Life 2021, 11(10), 1066; https://doi.org/10.3390/life11101066 - 10 Oct 2021
Cited by 4 | Viewed by 2175
Abstract
The purpose of this study was to compare the efficacy and safety of transarterial chemoembolization (TACE) plus sorafenib with those of TACE alone in patients with locally advanced hepatocellular carcinoma (HCC). Treatment-naïve patients with preserved hepatic reserve (Child–Pugh score ≤ 7) who received [...] Read more.
The purpose of this study was to compare the efficacy and safety of transarterial chemoembolization (TACE) plus sorafenib with those of TACE alone in patients with locally advanced hepatocellular carcinoma (HCC). Treatment-naïve patients with preserved hepatic reserve (Child–Pugh score ≤ 7) who received TACE plus sorafenib (n = 91) or TACE alone (n = 109) for locally advanced HCC with macrovascular invasion were retrospectively evaluated. Propensity score matching (PSM) was used to correct selection bias, and 63 pairs were created. In the entire study population, the median progression-free survival (PFS) and overall survival (OS) with TACE plus sorafenib were better than those with TACE alone. After PSM, the median PFS (7.0 vs. 4.3 months; p = 0.017) and OS (17.5 vs. 12.8 months; p = 0.049) were again significantly longer with TACE plus sorafenib than with TACE alone. Stratified Cox regression analysis and doubly robust estimation revealed that treatment type was significantly associated with both PFS and OS. In the subgroup analysis, TACE plus sorafenib did not show a significant survival benefit for patients with main portal vein or inferior vena cava invasion. Major complications were similar in both groups (p = 0.330). In conclusion, TACE plus sorafenib showed better survival outcomes than TACE alone in patients with locally advanced HCC. Full article
(This article belongs to the Special Issue Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma)
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12 pages, 1079 KiB  
Article
Association between Time to Local Tumor Control and Treatment Outcomes Following Repeated Loco-Regional Treatment Session in Patients with Hepatocellular Carcinoma: A Retrospective, Single-Center Study
by Krzysztof Bartnik, Wacław Hołówko and Olgierd Rowiński
Life 2021, 11(10), 1062; https://doi.org/10.3390/life11101062 - 9 Oct 2021
Cited by 1 | Viewed by 1556
Abstract
Background: Whether the number of loco-regional treatment sessions and the time required to obtain local tumor control (LTC) affects the prognosis of patients with hepatocellular carcinoma (HCC) remains controversial. This study aimed to determine whether a longer time to LTC is a significant [...] Read more.
Background: Whether the number of loco-regional treatment sessions and the time required to obtain local tumor control (LTC) affects the prognosis of patients with hepatocellular carcinoma (HCC) remains controversial. This study aimed to determine whether a longer time to LTC is a significant and independent predictor of poor treatment outcomes. Methods: In this retrospective study, we analyzed data of 139 treatment-naive patients with HCC who were not eligible for a treatment other than transarterial chemoembolization (TACE) at baseline. The outcome analyses were performed using the Cox proportional hazard model and Kaplan–Meier method, while the overall survival (OS) and progression free survival (PFS) were the primary study endpoints. Results: Overall, LTC was achieved in 82 (59%) of patients, including 67 (81%) patients who achieved LTC following TACE sessions alone and 15 (19%) subjects required additional ablation session. The median OS did not differ significantly between groups that needed 2, 3, or >3 locoregional treatment sessions to achieve LTC (p = 0.37). Longer time to LTC (in weeks) was significantly associated with shorter OS in univariate analysis (p = 0.04), but not in an adjusted model (p = 0.14). Both univariate and adjusted analyses showed that longer time to reach LTC was significantly associated with shorter PFS (adjusted HR = 1.04, 95% CI 1.001–1.09, p = 0.048). Conclusions: These findings show that the longer time to LTC is not an independent predictor of OS, but suggest that PFS may be significantly shorter in patients with longer time to LTC. Full article
(This article belongs to the Special Issue Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma)
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13 pages, 3385 KiB  
Article
Chemoembolization for Single Large Hepatocellular Carcinoma with Preserved Liver Function: Analysis of Factors Predicting Clinical Outcomes in a 302 Patient Cohort
by Gun Ha Kim, Jin Hyoung Kim, Ju Hyun Shim, Heung-Kyu Ko, Hee Ho Chu, Ji Hoon Shin, Hyun-Ki Yoon, Gi-Young Ko and Dong Il Gwon
Life 2021, 11(8), 840; https://doi.org/10.3390/life11080840 - 17 Aug 2021
Cited by 12 | Viewed by 2972
Abstract
The purpose of this study was to define the role of transcatheter arterial chemoembolization (TACE) in patients with a single large hepatocellular carcinoma (HCC) and define the patient groups benefiting from TACE. Treatment-naïve patients with preserved liver function who received TACE as the [...] Read more.
The purpose of this study was to define the role of transcatheter arterial chemoembolization (TACE) in patients with a single large hepatocellular carcinoma (HCC) and define the patient groups benefiting from TACE. Treatment-naïve patients with preserved liver function who received TACE as the first-line treatment for single large (>5 cm) HCC without macrovascular invasion and extrahepatic metastasis between 2007 and 2019 were retrospectively analyzed. Overall survival, progression-free survival, radiologic tumor response, complications, and predictors of survival were analyzed using multivariate analysis, and then a pretreatment risk-prediction model was created using the four predictive factors of tumor size, tumor type, ALBI grade, and ECOG performance status. Patients with scores of 0 (n = 54), 1–2 (n = 170), and 3–6 (n = 78) according to the model were classified as low-, intermediate-, and high-risk, respectively. The corresponding median OS values were 141, 55, and 28 months, respectively. The percentage of major complications increased as tumor size increased (4–21%). Asymptomatic, nodular HCC patients with a tumor size of 5–7 cm and ALBI grade 1 benefited the most from TACE. By contrast, the value of TACE in the treatment of single huge HCC (>10 cm) with high complication rates remains unclear. Full article
(This article belongs to the Special Issue Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma)
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10 pages, 657 KiB  
Article
Transarterial Chemoembolization of Hepatocellular Carcinoma with Oncozene Microspheres: An Initial, Short-Term Clinical Experience—A Retrospective, Matched, Comparison Study
by Matthew L. Hung, Jerry Jiang, Harry Trieu, Frank Hao, Navid Eghbalieh, Peng-Xu Ding and Edward Wolfgang Lee
Life 2021, 11(7), 600; https://doi.org/10.3390/life11070600 - 23 Jun 2021
Viewed by 2099
Abstract
Background: The purpose of this study is to describe a single institution’s experience using Oncozene (OZ) microspheres for transarterial chemoembolization (OZ-TACE) of hepatocellular carcinoma (HCC), and to compare tolerability, safety, short-term radiographic tumor response, progression-free survival (PFS), and overall survival (OS) of these [...] Read more.
Background: The purpose of this study is to describe a single institution’s experience using Oncozene (OZ) microspheres for transarterial chemoembolization (OZ-TACE) of hepatocellular carcinoma (HCC), and to compare tolerability, safety, short-term radiographic tumor response, progression-free survival (PFS), and overall survival (OS) of these procedures to TACE (LC-TACE) performed with LC beads (LC). Methods: A retrospective, matched cohort study of patients undergoing DEB-TACE (drug-eluting bead transarterial chemoembolization) with OZ or LC was performed. The cohort comprised 23 patients undergoing 29 TACE with 75 or 100 μm OZ and 24 patients undergoing 29 TACE with 100–300 μm LC. Outcome measures were changes in liver function tests, complications, treatment tolerability, short-term radiographic tumor response according to modified RECIST criteria for HCC, PFS, and 1-year OS. The Mann–Whitney U test, Fisher exact test, and log rank test were used to compare the groups. Results: The BCLC or Child–Pugh scores were similar between the OZ and LC group. However, the two groups differed with respect to the etiology of background cirrhosis (p = 0.02). All other initial demographic and tumor characteristics were similar between the two groups. OZ-TACE used less doxorubicin per treatment compared to LC-TACE (median 50 vs. 75 mg; p = 0.0005). Rates of pain, nausea, and postembolization syndrome were similar, irrespective of the embolic agent used. OZ-TACE resulted in an overall complication rate comparable to LC-TACE (20.7% vs. 10.3%; p = 0.47). LC-TACE resulted in a higher percent increase in total bilirubin on post-procedure day 1 (median 18.8 vs. 0%; p = 0.05), but this difference resolved at 1 month. Both OZ-TACE and LC-TACE resulted in similar complete (31% vs. 24%) and objective (66% vs. 79%) target lesion response rates on 1-month post-TACE imaging. Both OZ-TACE and LC-TACE had similar median progression-free survival (283 vs. 209 days; p = 0.14) and 1-year overall survival rates (85% vs. 76%; p = 0.30). Conclusion: With a significantly reduced dose of doxorubicin, TACE performed with Oncozene microspheres in a heterogeneous patient population is well-tolerated, safe, and produces a similar radiological response and survival rate when compared to LC Bead TACE. Full article
(This article belongs to the Special Issue Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma)
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10 pages, 1748 KiB  
Article
Initial Transarterial Chemoembolization (TACE) Using HepaSpheres 20–40 µm and Subsequent Lipiodol TACE in Patients with Hepatocellular Carcinoma > 5 cm
by Su Min Cho, Hee Ho Chu, Jong Woo Kim, Jin Hyung Kim and Dong Il Gwon
Life 2021, 11(4), 358; https://doi.org/10.3390/life11040358 - 18 Apr 2021
Cited by 2 | Viewed by 3728
Abstract
Purpose: To investigate clinical outcomes of drug-eluting bead transarterial chemoembolization (DEB-TACE) using HepaSpheres 20–40 µm in diameter and subsequent cisplatin-based lipiodol TACE (Cis-TACE) in patients with hepatocellular carcinoma (HCC) > 5 cm. Materials and Methods: This study included 39 consecutive patients (34 men, [...] Read more.
Purpose: To investigate clinical outcomes of drug-eluting bead transarterial chemoembolization (DEB-TACE) using HepaSpheres 20–40 µm in diameter and subsequent cisplatin-based lipiodol TACE (Cis-TACE) in patients with hepatocellular carcinoma (HCC) > 5 cm. Materials and Methods: This study included 39 consecutive patients (34 men, 5 women; mean age, 63.5 years; range, 39–80 years) who underwent DEB-TACE using HepaSpheres 20–40 µm as first-line treatment for HCC > 5 cm (mean diameter, 8.2 cm; range, 5.1–13 cm) between September 2018 and August 2019. Patients with new tumors, residual tumors, or tumor growth after initial DEB-TACE underwent subsequent Cis-TACE. Results: All 39 patients underwent initial DEB-TACE successfully, with 35 (89.7%) and three (7.7%) patients experiencing minor and major complications, respectively. After initial DEB-TACE, one patient (2.6%) achieved complete response (CR), 35 (89.7%) achieved partial response (PR), and three (7.7%) experienced progressive disease (PD). During a median follow-up period of 14.4 months (range, 0.6–23 months), 23 patients underwent Cis-TACE, with 11, three, and nine achieving CR, PR, and PD, respectively. The median overall survival time was 20.9 months (95% confidence interval (CI), 18.6–23.2 months), the median time to progression was 8.8 months (95% CI, 6.5–11.1 months), and the median time to local tumor recurrence was 16 months (95% CI, 7.4–24.6 months). Conclusions: DEB-TACE using HepaSpheres 20–40 µm in diameter can be a safe and effective initial treatment method in patients with HCC > 5 cm. Subsequent Cis-TACE constitutes a good adjuvant method to enhance tumor response after initial DEB-TACE. Full article
(This article belongs to the Special Issue Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma)
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