Authors E. DRESEN (1), E. KLOMPENHOUWER (1), C. VERSLYPE (2), V. VANDECAVEYE (1), G. MALEUX (1) / [1] UZ Leuven, Leuven, Belgium, Department of Radiology, [2] UZ Leuven, Leuven, Belgium, Department of Hepatology
Introduction Transarterial chemoembolization (TACE) is the most widely used locoregional treatment for intermediate stage hepatocellular carcinoma (HCC). Transarterial radioembolization (TARE) is an emerging interventional treatment that could be complementary or an alternative to TACE.
Aim
To determine the safety and efficacy of TARE in patients who have previously undergone transarterial chemoembolization with drug-eluting beads (DEB-TACE) for HCC.
Methods We retrospectively identified 30 patients who received one or more sessions of DEB-TACE prior to TARE for HCC in the period 2007-2016. There were 15 patients in Barcelona Clinical Liver Cancer Stage stage B (50%) and 15 (50%) in stage C. Adverse events grade > 3 were graded according to Common Terminology Criteria for Adverse events. Response on MRI was determined by mRECIST and ADCratio. Survival was determined since the first TACE and since the TARE procedure.
Results Patients had a mean of 1.7 TACE procedures (range 1-4) prior to TARE. The indication to switch to TARE was progressive disease (63.3%) and stable disease (33.3%) despite DEB-TACE, or new portal vein thrombosis (3.3%). Grade 3-4 adverse events following TARE included: fatigue (20%), bilirubin increase (10%), cholecystitis (3.3%) and a gastric ulcer (3.3%). Radiologic response rates based on mRECIST and ADCratio were 43% and 64%, respectively. Radiological progression rate was 36% for both mRECIST and ADCratio. Three patients (10%) were downstaged within the Milan criteria and received a liver transplantation. Of the 19 patients who died during the follow-up period, the mean overall survival since first TACE was 24 months (range 4-45), the mean overall survival since TARE was 15 months (range 1-27).
Conclusions TARE following DEB-TACE is a safe and efficient treatment strategy in patients with HCC, with the potential to downstage to liver transplantation.
