Comparison of conventional transarteryel chemoembolization and chemoembolization with doxorubicin drug eluting beads for unresectable hepatocelluar carcinoma: Retrospective study

BACKGROUND AND OBJECTIVES: Transarterial chemoembolization (TACE) is the only palliative treatment method that provides a positive survival ratefor the patients with unresectable hepatocelluar carcinoma (HCC). However there is no consensus on the use of chemical agents, embolic materials, or technical details of the TACE procedures. Drug eluting beads (DEB) is a novel locoregional treatment modality for unresectable HCC. DEB TACE may provide more effective tumor necrosis and well tolarated by patients when compared with the conventional chemoembolization. Unfortunately, the survival outcomes with DEB-TACE were not significantly different from those of conventional TACE. The aim of current study is to compare the treatment results concerning the tumor response, complications after treatment, and survival in unresectable HCC patients treated with DEB TACE or conventional TACE. MATERIAL AND METHOD: Records of unresectable HCC patients treated with transcatheter therapies at Dokuz Eylul University Hospital Interventional Radyology Unit between 2004-2013 were studied retrospectivly. Conventional TACE was performed by administering doxorubicin in an emulsion with lipiodol followed by embolization with polyvinyl alcohol (PVA) particles through a selective catheterization of tumor feeding arteries . DEB TACE was performed using DC Beads impregnated with doxorubicin. Statistical analysis was performed using Kaplan?Meier estimator with Wilcoxon and log-rank testing, chi-squared, and independent t-tests. RESULTS: Sixty-four patients (92 transcatheter therapies) met criteria for inclusion in this analysis. 41(44,5%) of the 91 interventions were conventional TACE. The rest were trated by DEB method.. The two TACE groups were similar with respect to age, gender, Child?Pugh-Okuda-BCLC-CLIP class, mean tumor size, tumor burden, and average of sessions per patient (p>0,05). In Okuda stage I patients rational response of the tumor to treatment was observed in 50% of the patients in conventional TACE and in 77,8% of those in DEB TACE group; significant differences were found (p=0,018). Serious complications like liver abscesses were more frequent at convensional TACE group (in conventional TACE group 26,8%, and in DEB TACE group 3,9%; p=0,002). Median survival times from the diagnosis of HCC in those treated with conventional TACE and DEB TACE were 8,3 (0,9-15,7) and 18,3 months (9,7-26,9; p=0,004) respectively. CONCLUSIONS: There is no standard method for TACE treatment in patients with unresectable (HCC). Survival benefits derived from different techniques are controversial. In our study, it has been found that DEB TACE is a safe and effective method in treatment of selected HCC patients. DEB TACE offers a survival advantage over conventional TACE for patients with unresectable HCC. KEY WORDS: Hepatocellular carcinoma, Drug eluiting beads, conventional chemoembolization