Transarterial chemoembolization with doxorubicin-loaded radiopaque beads for hepatocellular carcinoma: Safety, efficacy, and distribution

Abstract

Aim: To evaluate the safety and efficacy of transarterial chemoembolization with radiopaque doxorubicin-loaded microspheres (rDEB-TACE) in patients with hepatocellular carcinoma (HCC). Materials and Methods: This single-center, retrospective, observational study included all patients 18 years and older diagnosed with HCC and treated with rDEB-TACE from 2017 to 2020 at our institution. rDEB-TACE efficacy was evaluated by type of response after treatment at 1-, 3- and 6-month, time to progression (TTP), and overall survival (OS). Safety of the technique was assessed based on the occurrence of adverse events (AEs). rDEB distribution was classified by overall distribution as type 1: intratumoral, type 2: intratumoral-feeding artery, and type 3: feeding artery and by intratumoral distribution in 0-50% and 50-100%. Results: Twenty-one patients with 36 lesions treated with rDEB-TACE were included. Median follow-up time was 17 months (IQR: 6.0-45.5). Local and overall objective response at 1, 3 and 6 months was 86%, 85%, 84% and 91%, 78% and 84%, respectively. Median TTP was 27.0 months (95%CI: 8.9-28.1) and median OS was 54.9 months (95%CI: 16.3-NE). No major AEs were reported. The most common particle distribution was type 2 (69.4%). Concordance of particle distribution between intraprocedural cone beam CT and follow-up CT was high (kappa = 0.80). Most lesions treated showed a 50-100% intratumoral particle distribution, with higher rates of local (95.5% vs 71.4%) and overall objective response in this group (100% vs 71.4%) compared with the 0-50% group. Conclusion: rDEB-TACE is a safe and effective treatment for patients with HCC. Distribution of rDEB can be accurately assessed during and after the procedure and may predict early response.