Source Radiology Department. Barcelona Clinic Liver Cancer (BCLC) group. Hospital Clinic Barcelona. IDIBAPS. University of Barcelona, Spain.
BACKGROUND: TACE improves survival of properly selected HCC patients. Drug eluting beads (DEB) provide a calibrated and homogenous procedure while increasing efficacy. Outcome data applying this technology is lacking, and this is instrumental for clinical decision making and for trial design.
AIM: We evaluated the survival of HCC patients treated with DEB-TACE following a strict selection (preserved liver function, absence of symptoms, extrahepatic spread or vascular invasion).
PATIENTS/METHODS: We registered baseline characteristics, the development of treatment related adverse events, and the overall survival of all HCC patients treated by DEB-TACE from February 2004/June 2010.
RESULTS: 104 patients were treated with DEB-TACE. All but one were cirrhotic, 62.5% HCV+, 95% Child-Pugh A, 41 BCLC-A and 63 BCLC-B. Causes of DEB-TACE treatment in BCLC-A patients were: 35 unfeasible ablation, 6 post-treatment recurrences. After a median follow up of 24.5 months, 38 patients had died, two patients had received transplantation and 24 sorafenib because of untreatable tumour progression. Median survival of the cohort was 48.6 months (95%CI: 36.9-61.2), while it was 54.2 months in BCLC stage A and 47.7 months in stage B. Median survival after censoring follow-up at the time of transplant/sorafenib was 47.7 (95%CI: 37.9-57.5) months.
CONCLUSION: These data validate the safety of DEB-TACE and expose that the survival expectancy applying current selection criteria and technique is better than that previously reported. A 50% survival at 4 years should be considered when suggesting treatment for patients fitting into controversial scenarios such as expanded criteria for transplantation/resection for multifocal HCC.