Abstract
Transarterial chemoembolization (TACE) is the first-line treatment in patients with unresectable hepatocellular carcinoma (HCC). In recent years, there has been increasing clinical evidence that drug-eluting beads provide a combined ischemic and cytotoxic effect that may be superior to conventional TACE, with low systemic toxicity. The therapeutic value of TACE performed using the embolic microsphere DC Bead loaded with doxorubicin (drug-eluting bead doxorubicin [DEBDOX]) has been shown by several randomized controlled trials. Since Lencioni et al. [Cardiovasc Intervent Radiol 2012; 35: 980–985] published the first widely accepted technical recommendations on HCC embolization with DEBDOX-TACE in 2012, new studies have contributed to a better understanding of when and how to apply this new therapeutic modality, and they have yet to be incorporated into an updated guideline. Additionally, differences in the underlying liver pathology and practice of transcatheter embolization between Asian and Western populations have not been adequately addressed, and there remain significant variations in the TACE protocols adopted in different parts of the world. These mainly revolve around the number and type of chemotherapeutic agents used, type of embolic material, reliance on Lipiodol, and selectivity of catheter positioning. As a result of these issues, it has been difficult to interpret and compare results obtained from different centers in a systematic fashion. To address these concerns, we convened a panel of experts specializing in different aspects of HCC treatment to craft an updated set of recommendations that better reflect recent clinical experiences and are tailored to the use of DEBDOX-TACE in Taiwan. The conclusions of this expert panel are described in the following article.
Journal Section:
Consensus Statement
References
1.
Lencioni R, de Baere T, Burrel M, et al: Transcatheter treatment of hepatocellular carcinoma with doxorubicin-loaded DC Bead (DEBDOX): technical recommendations. Cardiovasc Intervent Radiol 2012; 35: 980–985.
[PubMed]
2.
Zhu RX, Seto WK, Lai CL, Yuen MF: Epidemiology of hepatocellular carcinoma in the Asia-Pacific region. Gut Liver 2016; 10: 332–339.
[PubMed]
3.
Lai CL, Ratziu V, Yuen MF, Poynard T: Viral hepatitis B. Lancet 2003; 362: 2089–2094.
[PubMed]
4.
Nordenstedt H, White DL, El-Serag HB: The changing pattern of epidemiology in hepatocellular carcinoma. Dig Liver Dis 2010; 42(suppl 3):S206–S214.
[PubMed]
5.
Wu CY, Chen YJ, Ho HJ, et al: Association between nucleoside analogues and risk of hepatitis B virus-related hepatocellular carcinoma recurrence following liver resection. JAMA 2012; 308: 1906–1914.
[PubMed]
6.
Changchien CS, Chen CL, Yen YH, et al: Analysis of 6,381 hepatocellular carcinoma patients in southern Taiwan: prognostic features, treatment outcome, and survival. J Gastroenterol 2008; 43: 159–170.
[PubMed]
7.
Liaw YF, Chu CM: Hepatitis B virus infection. Lancet 2009; 373: 582–592.
[PubMed]
8.
Lunn RM, Zhang YJ, Wang LY, et al: p53 mutations, chronic hepatitis B virus infection, and aflatoxin exposure in hepatocellular carcinoma in Taiwan. Cancer Res 1997; 57: 3471–3477.
[PubMed]
9.
Yuen MF, Hou JL, Chutaputti A; Asia Pacific Working Party on Prevention of Hepatocellular Carcinoma: Hepatocellular carcinoma in the Asia pacific region. J Gastroenterol Hepatol 2009; 24: 346–353.
[PubMed]
10.
But DY, Lai CL, Yuen MF: Natural history of hepatitis-related hepatocellular carcinoma. World J Gastroenterol 2008; 14: 1652–1656.
[PubMed]
11.
Llovet JM, Bruix J: Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 2003; 37: 429–442.
[PubMed]
12.
Vogl TJ, Naguib NN, Nour-Eldin NE, et al: Review on transarterial chemoembolization in hepatocellular carcinoma: palliative, combined, neoadjuvant, bridging, and symptomatic indications. Eur J Radiol 2009; 72: 505–516.
[PubMed]
13.
Kee KM, Wang JH, Wang CC, et al: Hepatocellular carcinoma associated with extra-hepatic primary malignancy: its secular change, clinical manifestations and survival. Sci Rep 2016; 6: 30156.
[PubMed]
14.
Kee KM, Wang JH, Lin CY, et al: Validation of the 7th edition TNM staging system for hepatocellular carcinoma: an analysis of 8,828 patients in a single medical center. Dig Dis Sci 2013; 58: 2721–2728.
[PubMed]
15.
Wang JH, Changchien CS, Hu TH, et al: The efficacy of treatment schedules according to Barcelona Clinic Liver Cancer staging for hepatocellular carcinoma – survival analysis of 3,892 patients. Eur J Cancer 2008; 44: 1000–1006.
[PubMed]
16.
Lammer J, Malagari K, Vogl T, 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: 41–52.
[PubMed]
17.
Lewis AL, Gonzalez MV, Lloyd AW, et al: DC Bead: in vitro characterization of a drug-delivery device for transarterial chemoembolization. J Vasc Interv Radiol 2006; 17(2 Pt 1): 335–342.
[PubMed]
18.
Toyoda H, Kumada, T, Tada T, et al: Transarterial chemoembolization for hepatitis B virus-associated hepatocellular carcinoma: improved survival after concomitant treatment with nucleoside analogues. J Vasc Interv Radiol 2012; 23: 317–322.
[PubMed]
19.
Varela M, Real MI, Burrel M, et al: Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 2007; 46: 474–481.
[PubMed]
20.
Vogl TJ, Lammer J, Lencioni R, et al: Liver, gastrointestinal, and cardiac toxicity in intermediate hepatocellular carcinoma treated with PRECISION TACE with drug-eluting beads: results from the PRECISION V randomized trial. AJR Am J Roentgenol 2011; 197:W562–W570.
[PubMed]
21.
Malagari K, Pomoni M, Kelekis A, et al: Prospective randomized comparison of chemoembolization with doxorubicin-eluting beads and bland embolization with BeadBlock for hepatocellular carcinoma. Cardiovasc Intervent Radiol 2010; 33: 541–551.
[PubMed]
22.
OCEBM Levels of Evidence Working Group: The Oxford Levels of Evidence 2. Oxford, Oxford Centre for Evidence-Based Medicine, 2017. http://www.cebm.net/index.aspx?o=5653 (accessed November 18, 2017).
23.
Song MJ, Chun HJ, Song DS, et al: Comparative study between doxorubicin-eluting beads and conventional transarterial chemoembolization for treatment of hepatocellular carcinoma. J Hepatol 2012; 57: 1244–1250.
[PubMed]
24.
Elsayes KM, Hooker JC, Agrons MM, et al: 2017 version of LI-RADS for CT and MR imaging: an update. Radiographics 2017; 37: 1994–2017.
[PubMed]
25.
Martin R, Irurzun J, Munchart J, et al: Optimal technique and response of doxorubicin beads in hepatocellular cancer: bead size and dose. Korean J Hepatol 2011; 17: 51–60.
[PubMed]
26.
Namur J, Citron SJ, Sellers MT, et al: Embolization of hepatocellular carcinoma with drug-eluting beads: doxorubicin tissue concentration and distribution in patient liver explants. J Hepatol 2011; 55: 1332–1338.
[PubMed]
27.
Song MJ, Park CH, Kim JD, et al: Drug-eluting bead loaded with doxorubicin versus conventional Lipiodol-based transarterial chemoembolization in the treatment of hepatocellular carcinoma: a case-control study of Asian patients. Eur J Gastroenterol Hepatol 2011; 23: 521–527.
[PubMed]
28.
Kalva SP, Pectasides M, Liu R, et al: Safety and effectiveness of chemoembolization with drug-eluting beads for advanced-stage hepatocellular carcinoma. Cardiovasc Intervent Radiol 2014; 37: 381–387.
[PubMed]
29.
Prajapati HJ, Dhanasekaran R, El-Rayes BF, et al: Safety and efficacy of doxorubicin drug-eluting bead transarterial chemoembolization in patients with advanced hepatocellular carcinoma. J Vasc Interv Radiol 2013; 24: 307–315.
[PubMed]
30.
Biocompatibles UK Ltd, a BTG International Group Company: Instruction for Use DC BeadTM. Farnham, DC BeadTM Instruction for Use CN00103.5 and CN000164.2, 2013.
31.
Cheng AL, Kang YK, Chen Z, et al: Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 2009; 10: 25–34.
[PubMed]
32.
Omata M, Lesmana LA, Tateishi R, et al: Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 2010; 4: 439–474.
[PubMed]
33.
Liapi E, Geschwind JF: Transcatheter arterial chemoembolization for liver cancer: is it time to distinguish conventional from drug-eluting chemoembolization? Cardiovasc Intervent Radiol 2011; 34: 37–49.
[PubMed]
34.
Watanabe T, Itabashi M, Shimada Y, et al: Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 2012; 17: 1–29.
[PubMed]
35.
Seki A, Hori S, Shimono C: Management of vascular lake phenomenon on angiography during chemoembolization with superabsorbent polymer microspheres. Jpn J Radiol 2015; 33: 741–748.
[PubMed]
36.
Seki A, Hori S, Kobayashi K, Narumiya S: Transcatheter arterial chemoembolization with epirubicin-loaded superabsorbent polymer microspheres for 135 hepatocellular carcinoma patients: single-center experience. Cardiovasc Intervent Radiol 2011; 34: 557–565.
[PubMed]
37.
Malagari K: Drug-eluting particles in the treatment of HCC: chemoembolization with doxorubicin-loaded DC Bead. Expert Rev Anticancer Ther 2008; 8: 1643–1650.
[PubMed]
38.
Kloeckner R, Weinmann A, Prinz F, et al: Conventional transarterial chemoembolization versus drug-eluting bead transarterial chemoembolization for the treatment of hepatocellular carcinoma. BMC Cancer 2015; 15: 465.
[PubMed]
39.
Lee KH, Liapi E, Vossen JA, et al: Distribution of iron oxide-containing Embosphere particles after transcatheter arterial embolization in an animal model of liver cancer: evaluation with MR imaging and implication for therapy. J Vasc Interv Radiol 2008; 19: 1490–1496.
[PubMed]
40.
Basile A, Carrafiello G, Ierardi AM, et al: Quality-improvement guidelines for hepatic transarterial chemoembolization. Cardiovasc Intervent Radiol 2012; 35: 765–774.
[PubMed]
41.
Virmani S, Ryu RK, Sato KT, et al: Effect of C-arm angiographic CT on transcatheter arterial chemoembolization of liver tumors. J Vasc Interv Radiol 2007; 18: 1305–1309.
[PubMed]
42.
Lencioni R, Petruzzi P, Crocetti L: Chemoembolization of hepatocellular carcinoma. Semin Intervent Radiol 2013; 30: 3–11.
[PubMed]
43.
Guiu B, Deschamps F, Aho S, et al: Liver/biliary injuries following chemoembolisation of endocrine tumours and hepatocellular carcinoma: Lipiodol versus drug-eluting beads. J Hepatol 2012; 56: 609–617.
[PubMed]
44.
Malagari K, Pomoni M, Spyridopoulos TN, et al: Safety profile of sequential transcatheter chemoembolization with DC Bead: results of 237 hepatocellular carcinoma (HCC) patients. Cardiovasc Intervent Radiol 2011; 34: 774–785.
[PubMed]
45.
Jin B, Wang D, Lewandowski RJ, et al: Chemoembolization endpoints: effect on survival among patients with hepatocellular carcinoma. AJR Am J Roentgenol 2011; 196: 919–928.
[PubMed]
46.
Geschwind JF, Ramsey DE, Cleffken B, et al: Transcatheter arterial chemoembolization of liver tumors: effects of embolization protocol on injectable volume of chemotherapy and subsequent arterial patency. Cardiovasc Intervent Radiol 2003; 26: 111–117.
[PubMed]
47.
Kobayashi N, Ishii M, Ueno Y, et al: Co-expression of Bcl-2 protein and vascular endothelial growth factor in hepatocellular carcinomas treated by chemoembolization. Liver 1999; 19: 25–31.
[PubMed]
48.
Xiong ZP, Yang SR, Liang ZY, et al: Association between vascular endothelial growth factor and metastasis after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2004; 3: 386–390.
[PubMed]
49.
Rhee TK, Young JY, Larson AC, et al: Effect of transcatheter arterial embolization on levels of hypoxia-inducible factor-1α in rabbit VX2 liver tumors. J Vasc Interv Radiol 2007; 18: 639–645.
[PubMed]
50.
Lencioni R, Llovet JM: Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010; 30: 52–60.
[PubMed]
© 2018 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2018
You do not currently have access to this content.
