Conventional Versus Drug Eluting Microspheres Transarterial Chemoembolization In Management Of Hepatocellular Carcinoma

Abstract

SUMMARY AND CONCLUSION v patocellular carcinoma (HCC) is the fifth most common cancer, the third most common cause of cancer death worldwide, and results in over 600,000 mortalities each year, rates of liver cancer in men are typically 2 to 4 times higher than in women (Bosch et al., 2004). Its incidence continues to increase, mainly because of the increasing incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections (El-Serag et al., 1999). Egypt has the highest prevalence of antibodies to hepatitis C virus in the world, estimated nationally at 14.7%. An estimated 9.8% are chronically infected (Miller et al., 2010). Trans-arterial chemoembolization combines the local delivery of chemotherapy with induction of tumour ischemia through occlusion of feeding vessels. Trans-arterial chemoembolization has the dual benefit of focusing treatment on the lesions and reducing the adverse effects of systemic exposure to chemotherapy. Drug-eluting microspheres trans-arterial chemoembolization has been widely commercially available since 2006. Since then, Drug-eluting microspheres TACE has become the standard in many centers worldwide; numerous investigators believe it to be more beneficial than conventional TACE (Bargellini et al., 2014). C-TACE is considered one of the most effective palliative treatment options for patients with inoperable hepatic neoplasms. However, the severity of the side effects associated with this type of treatment make it suitable only for selected patients. Approximately 20% of patients develop acute hepatic decompensation after c-TACE even if, as occurs in the majority of cases, liver function returns to its pretreatment level within weeks. Only a minority of patients eventually develop irreversible liver failure. Recently, drug-eluting microspheres-TACE has emerged as a variation of c-TACE with the potential for the selective delivery of large amounts of drugs to the tumour for a prolonged period of time, thereby decreasing plasma levels of the chemo- therapeutic agent and related systemic effects. Only future randomized controlled trials focused on long-term survival rates will be able to confirm if drug-eluting microspheres-TACE can totally replace c-TACE as the standard treatment for patients with non-resectable hepatic neoplasms (Antonio Basile et al., 2012). Nonetheless, evidence is limited regarding the direct comparison of Drug-eluting microspheres and conventional TACE. Only four studies were conducted in a randomized, prospective fashion. All other trials were retrospective and mostly based on small patient samples or were lacking the assessment of hard endpoints (Roman Kloeckner et al., 2015).