Transarterial chemoembolisation for very early and early stage hepatocellular carcinoma: single-centre experience. Issue 2 (February 2023)

• Record Type: Journal Article
• Authors: Hashem, E.; Sait, S.; Thomas, D. Nicholson; Watson, C.; Moeen, S.; Peddu, P.
• Is Part Of: Clinical radiology. Volume 78:Issue 2(2023)
• Page Start: e113
• Page End: e122
• Publication Date: 2023-02
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2022.09.120
• Languages: English
• ISSNs: 0009-9260

Abstract

Abstract : Aim: To evaluate the safety and efficacy of transarterial chemoembolisation (TACE) in patients with very early and early stage hepatocellular carcinoma (VES-HCC). Materials and methods: A retrospective analysis was performed for all TACE procedures done at King's College Hospital, a tertiary liver centre, for VES-HCC during a 5-year period (January 2014–December 2018). Patients with solitary tumours ≤5 cm and patients with 2–3 tumours (each ≤3 cm) were included. Results: Two hundred and thirty-seven eligible patients were included. Technical success was achieved in 233 (98.3%) procedures. TACE using drug-eluting beads (DEB-TACE) was performed in 192 (82.4%) procedures. A complete response was achieved in 109 (45.9%) patients. The recurrence rate was 44% (48 cases), during a median imaging follow-up of 31.9 months (IQR 15.9–44.7). Median overall survival was 71.1 months (95% confidence interval [CI]: 62.9–79.3). Median recurrence-free survival was 58.9 months (95% CI: 47.1–70.7). Sixty-six (27.8%) patients eventually underwent transplantation, and six (2.5%) patients underwent surgical resection. Mild, moderate, and severe adverse events were encountered in 2.9%, 5.4%, and 0.8% of cases, respectively. No 30-day mortality was encountered. Conclusion: DEB-TACE is safe and effective for treating VES-HCC patients, who are unsuitable for thermal ablation or surgery, and may offer comparable survival benefit. It can also be used as a bridge to transplantation for these patients. Highlights: DEB TACE is safe and effective for small HCC (BCLC stages 0 and A). DEB TACE is safe and effective for very early and early stage HCC. DEB TACE is useful when thermal ablation is infeasible (e.g., difficult anatomy). DEB TACE is useful when liver transplantation and surgical resection are infeasible. DEB TACE is suitable for bridging to liver transplantation in BCLC stage 0 and A.