Transarterial chemoembolization with doxorubicin-loaded radiopaque beads for hepatocellular carcinoma: Safety, efficacy, and distribution

Aim

To evaluate the safety and efficacy of transarterial chemoembolization with radio-paque doxorubicin-loaded microspheres (rDEB-TACE) in patients with hepatocellular carcinoma (HCC).

Materials and methods

This single-center, retrospective, observational study included all patients 18 years and older diagnosed with HCC and treated with rDEB-TACE from 2017 to 2020 at our institution. rDEB-TACE efficacy was evaluated by type of response after treatment at 1-,3- and 6-month, time to progression (TTP), and overall survival (OS). Safety of the techniquewas assessed based on the occurrence of adverse events (AEs). rDEB distribution was classified by overall distribution as type 1: intratumoral, type 2: intratumoral-feeding artery, and type 3: feeding artery and by intratumoral distribution in 0–50% and 50–100%.

Results

Twenty-one patients with 36 lesions treated with rDEB-TACE were included. Median follow-up time was 17 months (IQR: 6.0–45.5). Local and overall objective response at 1, 3 and 6 months was 86%, 85%, 84% and 91%, 78% and 84%, respectively. Median TTP was 27.0 months (95%CI: 8.9–28.1) and median OS was 54.9 months (95%CI: 16.3-NE). No major AEs were reported. The most common particle distribution was type 2 (69.4%). Concordance of particle distribution between intraprocedural cone beam CT and follow-up CT was high (kappa = 0.80). Most lesions treated showed a 50-100% intratumoral particle distribution, with higher rates of local (95.5% vs 71.4%) and overall objective response in this group (100% vs 71.4%) compared with the 0–50% group.

Conclusion

rDEB-TACE is a safe and effective treatment for patients with HCC. Distribution of rDEB can be accurately assessed during and after the procedure and may predict early response.