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Efficacy and Safety of Supplemental Transarterial Chemoembolization Through Extrahepatic Collateral Arteries with Drug-eluting Beads: Treatment for Unresectable Hepatocellular Carcinoma
Drug Design, Development and Therapy ( IF 4.7 ) Pub Date : 2020-11-17 , DOI: 10.2147/dddt.s266470 Sung-Hua Chiu , Ping-Ying Chang , Yu-Lueng Shih , Wen-Yen Huang , Kai-Hsiung Ko , Wei-Chou Chang , Guo-Shu Huang
Drug Design, Development and Therapy ( IF 4.7 ) Pub Date : 2020-11-17 , DOI: 10.2147/dddt.s266470 Sung-Hua Chiu , Ping-Ying Chang , Yu-Lueng Shih , Wen-Yen Huang , Kai-Hsiung Ko , Wei-Chou Chang , Guo-Shu Huang
Purpose: To evaluate the therapeutic efficacy and safety of supplement transarterial chemoembolization (TACE) with drug-eluting beads TACE (DEB-TACE) through extrahepatic collateral (EHC) arteries for the treatment of hepatocellular carcinoma (HCC).
Patients and Methods: In this retrospective study, 61 unresectable HCC patients with treatment-naïve EHC blood supplies who received TACE from January 2016 to March 2019 were enrolled; of these patients, 42 (68.9%) received DEB-TACE, and 19 (31.1%) received cTACE. The hepatic tumor feeding arteries were treated in the same TACE session if it presented. The tumor response, time-to-progression (TTP), and overall survival (OS) were analyzed. Safety was assessed based on the occurrence of liver function deterioration and major complications within three months after TACE.
Results: DEB-TACE showed better efficacy than cTACE in the disease control rate (p=0.001), overall response rate (p=0.005), the TTP (eight months vsthree months, p=0.002) and the OS (23.8 months vs nine months, p=0.045). Nine patients in the DEB-TACE group and one patient in the cTACE group were downstaged to resection or liver transplantation (21.4% vs 5.3%, p=0.151). DEB-TACE and cTACE have no difference in the acute and chronic liver toxicity. With regard to complications, there was no significant difference in the occurrence of both major (16.7% vs 21.1%, p=0.72) and minor (57.1% vs 47.4%, p=0.48) complications between DEB-TACE and cTACE.
Conclusion: DEB-TACE through EHC arteries has a potential therapeutic effect in the treatment of unresectable HCC, with comparable safety compared with cTACE.
Keywords: hepatocellular carcinoma, chemoembolization, therapeutic, collateral circulation, cone-beam computed tomography
中文翻译：
药物洗脱珠通过肝外侧支动脉补充经动脉化疗栓塞的疗效和安全性：治疗不可切除的肝细胞癌
目的：评估通过肝外侧支 (EHC) 动脉补充经动脉化疗栓塞 (TACE) 与药物洗脱珠 TACE (DEB-TACE) 治疗肝细胞癌 (HCC) 的疗效和安全性。
患者和方法：在这项回顾性研究中，纳入了 2016 年 1 月至 2019 年 3 月接受 TACE 治疗的 61 名未接受过治疗的 EHC 血液供应的不可切除 HCC 患者；在这些患者中，42 人（68.9%）接受了 DEB-TACE，19 人（31.1%）接受了 cTACE。如果出现肝肿瘤供血动脉，则在同一 TACE 疗程中进行治疗。分析了肿瘤反应、进展时间（TTP）和总生存期（OS）。根据 TACE 后三个月内肝功能恶化和主要并发症的发生情况评估安全性。
结果： DEB-TACE在疾病控制率（p =0.001）、总体缓解率（p =0.005）、TTP（8个月vs3个月，p= 0.002）和 OS（23.8 个月 vs 9 个月，p = 0.045）。DEB-TACE 组 9 例患者和 cTACE 组 1 例患者降期为切除或肝移植（21.4% vs 5.3%，p = 0.151）。DEB-TACE和cTACE在急性和慢性肝毒性方面没有差异。在并发症方面， DEB-TACE 和 cTACE的主要（16.7% vs 21.1%， p = 0.72）和轻微（57.1% vs 47.4%，p = 0.48）并发症的发生率没有显着差异。
结论：经 EHC 动脉的 DEB-TACE 在治疗不可切除的 HCC 中具有潜在的治疗作用，与 cTACE 相比具有相当的安全性。
关键词：肝细胞癌, 化疗栓塞, 治疗, 侧支循环, 锥形束计算机断层扫描
更新日期：2020-11-17
Patients and Methods: In this retrospective study, 61 unresectable HCC patients with treatment-naïve EHC blood supplies who received TACE from January 2016 to March 2019 were enrolled; of these patients, 42 (68.9%) received DEB-TACE, and 19 (31.1%) received cTACE. The hepatic tumor feeding arteries were treated in the same TACE session if it presented. The tumor response, time-to-progression (TTP), and overall survival (OS) were analyzed. Safety was assessed based on the occurrence of liver function deterioration and major complications within three months after TACE.
Results: DEB-TACE showed better efficacy than cTACE in the disease control rate (p=0.001), overall response rate (p=0.005), the TTP (eight months vsthree months, p=0.002) and the OS (23.8 months vs nine months, p=0.045). Nine patients in the DEB-TACE group and one patient in the cTACE group were downstaged to resection or liver transplantation (21.4% vs 5.3%, p=0.151). DEB-TACE and cTACE have no difference in the acute and chronic liver toxicity. With regard to complications, there was no significant difference in the occurrence of both major (16.7% vs 21.1%, p=0.72) and minor (57.1% vs 47.4%, p=0.48) complications between DEB-TACE and cTACE.
Conclusion: DEB-TACE through EHC arteries has a potential therapeutic effect in the treatment of unresectable HCC, with comparable safety compared with cTACE.
Keywords: hepatocellular carcinoma, chemoembolization, therapeutic, collateral circulation, cone-beam computed tomography
中文翻译：
药物洗脱珠通过肝外侧支动脉补充经动脉化疗栓塞的疗效和安全性：治疗不可切除的肝细胞癌
目的：评估通过肝外侧支 (EHC) 动脉补充经动脉化疗栓塞 (TACE) 与药物洗脱珠 TACE (DEB-TACE) 治疗肝细胞癌 (HCC) 的疗效和安全性。
患者和方法：在这项回顾性研究中，纳入了 2016 年 1 月至 2019 年 3 月接受 TACE 治疗的 61 名未接受过治疗的 EHC 血液供应的不可切除 HCC 患者；在这些患者中，42 人（68.9%）接受了 DEB-TACE，19 人（31.1%）接受了 cTACE。如果出现肝肿瘤供血动脉，则在同一 TACE 疗程中进行治疗。分析了肿瘤反应、进展时间（TTP）和总生存期（OS）。根据 TACE 后三个月内肝功能恶化和主要并发症的发生情况评估安全性。
结果： DEB-TACE在疾病控制率（p =0.001）、总体缓解率（p =0.005）、TTP（8个月vs3个月，p= 0.002）和 OS（23.8 个月 vs 9 个月，p = 0.045）。DEB-TACE 组 9 例患者和 cTACE 组 1 例患者降期为切除或肝移植（21.4% vs 5.3%，p = 0.151）。DEB-TACE和cTACE在急性和慢性肝毒性方面没有差异。在并发症方面， DEB-TACE 和 cTACE的主要（16.7% vs 21.1%， p = 0.72）和轻微（57.1% vs 47.4%，p = 0.48）并发症的发生率没有显着差异。
结论：经 EHC 动脉的 DEB-TACE 在治疗不可切除的 HCC 中具有潜在的治疗作用，与 cTACE 相比具有相当的安全性。
关键词：肝细胞癌, 化疗栓塞, 治疗, 侧支循环, 锥形束计算机断层扫描
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