Purpose
Transarterial chemoembolisation (TACE) is indicated in patients with intermediate stage hepatcellular carcinoma (HCC)not suitable for transplantation or curative treatments or as a bridging therapy to livertransplantation.
The objective of TACE is to induce tumour necrosis via arterial occlusion. The response to treatment is then measured via changes in tumour enhancement on contrast imaging using criterias like the modified response evaluation criteria in solid tumours (mRECIST).
Several studies in the literature have showed a correlation between radiological response following TACE and overall survival. (Memon et al...
Methods and materials
Patient Selection:
A retrospective review of all TACE performed between Jan 2010 and Dec 2017 was performed. (Figure 1)
Patients receiving TACE for the first time were then selected out.
From this group, any patient who had previous treatments were excluded.
To allow for same modality imaging comparison, only patients with pre- and post-treatment multi-phase CT imaging within 3 months of the treatment were included in the final cohort, giving a study sample size of 110 patients.
There was no significant difference in survival between...
Results
Patient Demographics
The most common aetiology for liver cirrhosis is alcoholic liver disease followed by hepatitis. 83% of the patients were in the child A or B category. No significant difference in age, gender, aetiology , Child-Pugh status, performance status and the number of repeat TACE was demonstrated between theresponder and non-respondergroup. (Figure 4)
Tumour Necrosis
Patients were more likely to be responders (81%) compared to non-responders (19%). Individual response rates showed the most common response to be a partial success (60%) followed by complete...
Conclusion
This study demonstrates a significant survival advantage in responders compared to non-responders following TACE for HCC. Findings in this study are similar to previous investigations that have shown an association between the radiologic evaluation of tumour necrosis and survival.(Figure 9) In an ideal setting, treatment goals should focus on tumour eradication but anatomical factors, residual liver function and performance status may limit this pursuit.
A conundrum that arises from this study was whether patients with stable disease should undergo additional treatment as only a modest...
Personal information and conflict of interest
A. Tan; Glasgow/UK - nothing to disclose C. Stove; Glasgow/UK - nothing to disclose M. Philippou; PA1 3NQ/UK - nothing to disclose R. S. Kasthuri; Glasgow/UK - nothing to disclose I. Robertson; Glasgow/UK - nothing to disclose
References
K. Memon, L. Kulik, R. J. Lewandowski et al., “Radiographic response to locoregional therapy in hepatocellular carcinoma predicts patient survival times,” Gastroenterology, vol. 141, no. 2, pp. 526.e2–535.e2, 2011.
C. J. Kim, H. J. Kim, J. H. Park et al., “Radiologic response to transcatheter hepatic arterial chemoembolization and clinical outcomes in patients with hepatocellular cancer. Liver International, vol. 34, no. 2, pp. 305–312, 2014.
H. J. Prajapati, J. R. Spivey, S. I. Hanish et al., “mRECIST and EASL responses at early time point by contrast-enhanced...