Comparison between Conventional Transarterial Chemoembolization (cTACE) and Chemoembolization with Doxorubicin Drug Eluting Beads (DEB) in Treatment of Hepatocelluar Carcinoma

Abstract

Chemoembolization (TACE) is the most widely used primary treatment for unresectable HCC and the recommended first line-therapy for patients at intermediate stage of the disease. Conventional chemoembolization (cTACE) combines transcatheter delivery of chemotherapy mixed with lipiodol followed by vascular stagnation achieved with embolic agents (gel foam). While in TACE using drug eluting beads (DEBTACE) the embolic beads have the ability to sequester chemotherapeutic agents and release them in a controlled. This strategy has been shown to increase the local concentration of the drug with negligible systemic toxicity. This study was held to compare between the conventional transarterial chemoembolization (cTACE) and chemoembolization using the drug eluting beads (DEBTACE) in HCC patients regarding: 1- Post TACE Adverse events 2-Radiological response of the target lesion 3- Seven months survival Summary - 187 - Fifty HCC patients were included in the study, all of them Child (A or B) and BCLC (A or B) Group I included 25 patients underwent 37 sessions of DEBTACE and group II included 25 patients underwent 40 sessions of cTACE. All the patients were subjected to: 1-Complete history taking 2-Thorough clinical examination 3-Laboratory investigations including: Complete blood picture, liver profile (s.albumin, total and direct bilirubin, prothrombin time and liver enzymes) kidney function tests (serum creatinine, blood urea nitrogen, sodium and potassium), viral markers (HCV, HBsAg, HBcAb) and AFP. 4-Ultrasound to detect the hepatic focal lesion 5-Triphasic pelvi abdominal CT to diagnose HCC After the first TACE, all the patients were followed for at least 7 months (first, fourth and seventh months). In each visit, all patients were subjected to: 1-Laboratory investigations (CBC, LFT, KFT and AFP) 2-Triphasic pelvi-abdominal CT (to assess the radiological response according to mRECIST) Summary - 188 - Results of the current study showed that: 1-Regarding post procedure adverse events; it was found that TACE using drug eluting beads is considered a safe maneuver with less hepatotoxicity than conventional TACE (statistically significant difference). 2- Regarding the radiological response of the target lesion, the theory of superiority was not met between both groups, but there was a better trend towards DEBTACE than cTACE. 3-The overall response assessment showed no statistically differences between both groups. 4-Regarding the median survival time, it was higher in DEBTACE group (24 months) than cTACE (15 months) but still not statistically significant. 5-Median time to progression (TTP) was about 7 months in both groups.