Amy Robin Deipolyi MD, PhD, Presenter: Nothing to Disclose

Shehab A. Alansari MD, Abstract Co-Author: Nothing to Disclose

Rahmi Oklu MD, PhD, Abstract Co-Author: Nothing to Disclose

Zubin Irani MD, Abstract Co-Author: Nothing to Disclose

Raymond W. Liu MD, Abstract Co-Author: Nothing to Disclose

George Rachid De Oliveira MD, Abstract Co-Author: Nothing to Disclose

Andrew X. Zhu MD, PhD, Abstract Co-Author: Nothing to Disclose

Suvranu Ganguli MD, Abstract Co-Author: Research Grant, Merit Medical Systems, Inc Consultant, Boston Scientific Corporation

Prior work suggests that 100-300 μm drug-eluting beads (DEB) for transarterial chemoembolization (TACE) compared with 300-500 μm DEB are safer and more effective for hepatocellular carcinoma (HCC). We compared safety and efficacy of 70-150 μm to 100-300 μm DEB in TACE for HCC.

In 12/2012 our DEB-TACE protocol was changed from 2 vials of 100-300 μm to 1 vial of 70-150 μm and 1 vial of 100-300 μm DEB, which generated two groups of HCC patients for comparison selected under similar eligibility criteria. We reviewed laboratory and clinical data, post-TACE course, and response on 1-2 month imaging based on modified RECIST criteria. Fisher’s exact, χ2 and student’s t tests analyzed group differences.

Of 65 cases (54 patients) performed with 70-150 μm DEB (Group 1) and 67 cases (53 patients) with 100-300 μm DEB (Group 2), treatment was lobar in 60 and selective in 11 (Group 1) and lobar in 42 and selective in 7 cases (Group 2). There was no difference in pre-procedure age, stage, or liver function tests. There was a trend for greater decrease in index lesion size in Group 1 (–8 v +2%; p=0.4). Treatment response for Group 1 and 2 was similar inrates of complete response (16 v 23%), partial response (9 v 5%), stable disease (70 v 61%) and progressive disease (5 v 11%) (p=0.4). Group 1 patients were significantly more likely to be readmitted within 1 month or have prolonged hospital stay for complications related to liver dysfunction with more patients requiring treatment for ascites, symptoms of portal hypertension, and biliary disease (12 v 3; p=0.01). Two patients in Group 1 developed cholecystitis and 2 patients died within 2 months, compared to none in Group 2. Group 1 patients tended to have increased bilirubin post-procedure (+19 v –12%; p=0.07), more complications from any cause (24 v 16; p>0.05), longer hospital stay (1.5 v 1.1 days; p=0.07), and to visit doctors more frequently within 1 month (13 v 8; p>0.05).

Our results suggest that despite similar efficacy by imaging, TACE with smaller, 70-150 μm DEB leads to more liver-related complications, and possibly more adverse events from all causes and longer post-TACE hospitalization.

Transarterial chemoembolization with 70-150 μm compared with 100-300 μm drug eluting beads for hepatocellular carcinoma may cause more complications and longer hospitalization, despite similar efficacy. Findings suggest 100-300 μm beads may be optimal.

Deipolyi, A, Alansari, S, Oklu, R, Irani, Z, Liu, R, Oliveira, G, Zhu, A, Ganguli, S, Efficacy and Safety of 70-150 μm Compared with 100-300 μm Drug Eluting Beads in Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma: Does Size Matter?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008223.html