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The safety and efficacy of balloon-occluded transcatheter arterial chemoembolization for hepatocellular carcinoma refractory to conventional transcatheter arterial chemoembolization

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  • Published:
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Abstract

Objectives

To evaluate the safety and efficacy of balloon-occluded transcatheter arterial chemoembolization (B-TACE) for the treatment of HCC refractory to conventional TACE (C-TACE).

Methods

This single-center retrospective analysis included 60 consecutive patients who underwent B-TACE (mean age, 61.4 years; male:female ratio, 4.5:1) for the treatment of residual viable (n = 40) or recurrent HCC (n = 20) refractory to C-TACE between November 2017 and November 2018. Technical success, radiologic response rate (proportion of the patients achieving complete response [CR] or partial response [PR] on first follow-up CT according to m-RECIST), major complication rate, and time to progression (TTP) were evaluated. The TTP of B-TACE was also compared with that of the last C-TACE. Factors associated with achieving CR and TTP were explored.

Results

B-TACE resulted in 100% technical success and radiologic response rate (CR in 45 and PR in 15 patients). The major complication rate was 6.7% (4/60). The median TTP after B-TACE was 5.3 months (95% confidence interval [CI], 4.0–6.9 months). The TTP of B-TACE for treating residual HCC was significantly longer than that of the last C-TACE (median [95% CI], 4.4 [3.2–6.9] vs. 2.7 [2.3–4.4] months; p = 0.013). BCLC stage C (adjusted OR, 4.448; 95% CI, 1.691–11.700; p = 0.002) and multiplicity of HCC (adjusted OR, 2.746; 95% CI, 1.206–6.251; p = 0.016) were significantly associated with tumor progression after B-TACE.

Conclusions

B-TACE is safe and effective for the treatment of HCC refractory to C-TACE. BCLC stage C and multiplicity of HCC were independent factors associated with TTP after B-TACE.

Key Points

• B-TACE for the treatment of HCC refractory to C-TACE showed a 100% radiologic response at first follow-up and a significantly longer TTP than the last C-TACE when treating residual tumor.

• The major complication rate after B-TACE was 6.7%. Although AST, ALT, and total bilirubin increase were more profound in B-TACE than in the last C-TACE, these were normalized at the first follow-up.

• Tumor size, multiplicity of HCC, and hepatic arterial injury were independent factors associated with achieving a complete response. BCLC stage C and multiplicity of HCC were significantly associated with TTP after B-TACE.

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Abbreviations

AFP:

Alpha-fetoprotein

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

BCLC:

Barcelona Clinic Liver Cancer

BOSAP:

Balloon-occluded arterial stump pressure

B-TACE:

Balloon-occluded transcatheter arterial chemoembolization

CR:

Complete response

C-TACE:

Conventional transcatheter arterial chemoembolization

HCC:

Hepatocellular carcinoma

m-RECIST:

Modified Response Evaluation Criteria in Solid Tumors

PD:

Progressive disease

PIVKA:

Protein induced by vitamin K absence or antagonist

PR:

Partial response

TACE:

Transcatheter arterial chemoembolization

TTP:

Time to progression

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Pyeong Hwa Kim, Dong Il Gwon, Jong Woo Kim, Hee Ho Chu & Jin Hyoung Kim

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  1. Pyeong Hwa Kim
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  2. Dong Il Gwon
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  3. Jong Woo Kim
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  5. Jin Hyoung Kim
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Correspondence to Dong Il Gwon.

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Kim, P.H., Gwon, D.I., Kim, J.W. et al. The safety and efficacy of balloon-occluded transcatheter arterial chemoembolization for hepatocellular carcinoma refractory to conventional transcatheter arterial chemoembolization. Eur Radiol 30, 5650–5662 (2020). https://doi.org/10.1007/s00330-020-06911-9

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