Hepatosellüler Karsinomda İlaç Yüklenebilir Mikroküreler ile Yapılan Transarteriyel Kemoembolizasyonun Etkinliği: Tek Merkez Deneyimi

Year 2022, Volume: 24 Issue: 2, 105 - 109, 30.08.2022

Gürkan Danışan , Erbil Arık

https://doi.org/10.18678/dtfd.1075822

Abstract

Amaç: Bu çalışmanın amacı hepatosellüler karsinomda (HCC) ilaç salınımlı mikroküreler ile yapılan transarteriyel kemoembolizasyon (TAKE) tedavisinin etkinliğini değerlendirmektir.
Gereç ve Yöntemler: 2019 ve 2021 tarihleri arasında ilaç salınımlı mikroküreler ile TAKE uygulanan 29 HCC'li hasta çalışmaya dahil edildi. TAKE işleminin başarısı işlem öncesi ve sonrası kontrastlı bilgisayarlı tomografi ve manyetik rezonans görüntüleri ile değerlendirildi. Hasta karakteristikleri, embolizasyon için kullanılan mikroküre boyutları, işleme bağlı komplikasyonlar ve işlem öncesi ve sonrası alfa fetoprotein (AFP) düzeyleri kaydedildi.
Bulgular: Hastaların yaş ortalaması 65,6±10,4 yıldı ve objektif yanıt oranı %17,2 (5/29) idi. 11 (%37,9) hastada 100-300 μm ve 18 (%62,1) hastada 300-500 μm boyutlarında partikül kullanılmıştı. Ortanca hedef lezyon sayısı 1 (aralık, 1-6) idi. Altı (%20,7) hastada hedef olmayan lezyon mevcuttu. Dört (%13,8) hastada yeni gelişen lezyon mevcuttu. İşlem sonrası ortanca hedef lezyon boyutunda (41; aralık, 0-116 mm) işlem öncesi (42; aralık, 22-188 mm) ile karşılaştırıldığında anlamlı bir azalma olduğu saptandı (p<0,001). Ayrıca, işlem öncesi (343; aralık, 1,44-2000 ng/mL) ve işlem sonrası (52; aralık, 0,95-1435 ng/mL) ortanca AFP değerleri arasında anlamlı bir farklılık saptandı (p<0.001).
Sonuç: HCC hastalarının büyük bir kısmı intermediate evrede teşhis edildiğinden küratif tedavileri mümkün değildir. Bu hasta grubunda TAKE, hastalığın lokal kontrolünde önemli bir tedavi seçeneğidir. Bununla birlikte, TAKE tedavisinin başarısı kanser evresi, hasta sayısı, takip süresi ve kullanılan mikrokürenin tipi ve boyutuna göre değişkenlik gösterebilir.

Keywords

Hepatosellüler karsinom, transarteriyel kemoembolizasyon, ilaç salınımlı mikroküreler

Efficacy of Transarterial Chemoembolization with Drug-Eluting Beads in Hepatocellular Carcinoma: A Single-Center Experience

Abstract

Aim: The aim of this study was to evaluate the efficacy of transarterial chemoembolization (TACE) with drug-eluting beads in hepatocellular carcinoma (HCC).
Material and Methods: Twenty-nine patients with HCC who were treated with TACE with drug-eluting beads between 2019 and 2021 were included in the study. The success of the TACE procedure was evaluated using pre- and post-operative contrast-enhanced computed tomography/magnetic resonance images. Patient characteristics, embolizing-bead sizes, procedure-related complications, and pre- and post-procedure alpha-fetoprotein (AFP) levels were recorded.
Results: The mean age of the patients was 65.6±10.4 years, and the objective response rate was 17.2% (5/29). 100-300 μm particles were used in 11 (37.9%) patients, and 300-500 μm particles were used in 18 (62.1%). The median target lesion number was 1 (range, 1-6). Six (20.7%) patients had non-target lesions. There were newly developed lesions in four (13.8%) patients. A significant decrease was found in the median target lesion size after (41; range, 0-116 mm) the procedure compared to the pre- (42; range, 22-188 mm) procedure (p<0.001). A significant difference was found between the median AFP levels before (343; range, 1.44-2000 ng/mL) and after (52; range, 0.95-1435 ng/mL) the procedure (p<0.001).
Conclusion: Since most patients with HCC are diagnosed in the intermediate stage, curative treatment is not possible. TACE is an important treatment option for the local control of the disease in this patient group. However, the success of TACE treatment may vary depending on the cancer stage, number of patients, follow-up period, and type and size of the microsphere used.

Keywords

: hepatocellular carcinoma, transarterial chemoembolization, drug-eluting beads

References

• Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
• Bosetti C, Turati F, La Vecchia C. Hepatocellular carcinoma epidemiology. Best Pract Res Clin Gastroenterol. 2014;28(5):753-70.
• Poulou LS, Botsa E, Thanou I, Ziakas PD, Thanos L. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol. 2015;18(8):1054-63.
• Bipat S, van Leeuwen MS, Ijzermans JN, Comans EF, Planting AS, Bossuyt PM, et al. Evidence-base guideline on management of colorectal liver metastases in the Netherlands. Neth J Med. 2007;65(1):5-14.
• Bilchik AJ, Wood TF, Allegra D, Tsioulias GJ, Chung M, Rose DM, et al. Cryosurgical ablation and radiofrequency ablation for unresectable hepatic malignant neoplasms: a proposed algorithm. Arch Surg. 2000;135(6):657-64.
• Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018;391(10127):1301-14.
• Lanza E, Donadon M, Poretti D, Pedicini V, Tramarin M, Roncalli M, et al. Transarterial therapies for hepatocellular carcinoma. Liver Cancer. 2016;6(1):27-33.
• Gruber-Rouh T, Naguib NN, Eichler K, Ackermann H, Zangos S, Trojan J, et al. Transarterial chemoembolization of unresectable systemic chemotherapy-refractory liver metastases from colorectal cancer: long-term results over a 10-year period. Int J Cancer. 2014;134(5):1225-31.
• Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19(3):329-38.
• Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30(1):52-60.
• Grosso M, Vignali C, Quaretti P, Nicolini A, Melchiorre F, Gallarato G, et al. Transarterial chemoembolization for hepatocellular carcinoma with drug-eluting microspheres: preliminary results from an Italian multicentre study. Cardiovasc Intervent Radiol. 2008;31(6):1141-9.
• Lewis AL, Gonzalez MV, Lloyd AW, Hall B, Tang Y, Willis SL, et al. DC bead: in vitro characterization of a drug-delivery device for transarterial chemoembolization. J Vasc Interv Radiol. 2006;17(2 Pt 1):335-42.
• Hong K, Khwaja A, Liapi E, Torbenson MS, Georgiades CS, Geschwind JF. New intra-arterial drug delivery system for the treatment of liver cancer: preclinical assessment in a rabbit model of liver cancer. Clin Cancer Res. 2006;12(8):2563-7.
• Lewis AL, Taylor RR, Hall B, Gonzalez MV, Willis SL, Stratford PW. Pharmacokinetic and safety study of doxorubicin-eluting beads in a porcine model of hepatic arterial embolization. J Vasc Interv Radiol. 2006;17(8):1335-43.
• Jia G, Van Valkenburgh J, Chen AZ, Chen Q, Li J, Zuo C, et al. Recent advances and applications of microspheres and nanoparticles in transarterial chemoembolization for hepatocellular carcinoma. Wiley Interdiscip Rev Nanomed Nanobiotechnol. 2022;14(2):e1749.
• Zhou J, Liu Y, Ren Z, Zhang Y, Zhang M. Transarterial chemoembolization with gelatin sponge microparticles for barcelona clinic liver cancer Stage C and large hepatocellular carcinoma: Initial clinical experience. J Cancer Res Ther. 2017;13(5):767-72.
• Li W, Man W, Guo H, Yang P. Clinical study of transcatheter arterial chemoembolization combined with microwave ablation in the treatment of advanced hepatocellular carcinoma. J Cancer Res Ther. 2016;12(Supplement):C217-20.
• Hou YF, Wei YG, Yang JY, Wen TF, Xu MQ, Yan LN, et al. Combined hepatectomy and radiofrequency ablation versus TACE in improving survival of patients with unresectable BCLC stage B HCC. Hepatobiliary Pancreat Dis Int. 2016;15(4):378-85.
• Katsanos K, Kitrou P, Spiliopoulos S, Maroulis I, Petsas T, Karnabatidis D. Comparative effectiveness of different transarterial embolization therapies alone or in combination with local ablative or adjuvant systemic treatments for unresectable hepatocellular carcinoma: A network meta‑analysis of randomized controlled trials. PLoS One. 2017;12(9):e0184597.
• Biederman DM, Titano JJ, Bishay VL, Durrani RJ, Dayan E, Tabori N, et al. Radiation segmentectomy versus TACE combined with microwave ablation for unresectable solitary hepatocellular carcinoma up to 3 cm: A propensity score matching study. Radiology. 2017;283(3):895-905.
• Hu H, Chen GF, Yuan W, Wang JH, Zhai B. Microwave ablation with chemoembolization for large hepatocellular carcinoma in patients with cirrhosis. Int J Hyperthermia. 2018;34(8):1351-8.
• Ako S, Nakamura S, Nouso K, Dohi C, Wada N, Morimoto Y, et al. Transcatheter arterial chemoembolization to reduce size of hepatocellular carcinoma before radiofrequency ablation. Acta Med Okayama. 2018;72(1):47-52.
• Li X, Chen B, An C, Cheng Z, Han Z, Liu F, et al. Transarterial chemoembolization combined with microwave ablation versus microwave ablation only for Barcelona clinic liver cancer Stage B hepatocellular carcinoma: A propensity score matching study. J Cancer Res Ther. 2020;16(5):1027-37.
• Lammer J, Malagari K, Vogl T, Pilleul F, Denys A, Watkinson A, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol. 2010;33(1):41-52.
• Nouri YM, Kim JH, Yoon HK, Ko HK, Shin JH, Gwon DI. Update on transarterial chemoembolization with drug-eluting microspheres for hepatocellular carcinoma. Korean J Radiol. 2019;20(1):34-49.