Skip to main content
Top
Published in: Japanese Journal of Radiology 5/2021

01-05-2021 | Hepatocellular Carcinoma | Original Article

Whole-liver transcatheter arterial chemoinfusion and bland embolization with fine-powder cisplatin and trisacryl gelatin microspheres for treating unresectable multiple hepatocellular carcinoma

Authors: Akihiro Imamura, Hidetoshi Taguchi, Hideyuki Takano, Hiroyuki Funatsu, Kazuyoshi Nakamura, Hidehito Arimitsu, Satoshi Chiba

Published in: Japanese Journal of Radiology | Issue 5/2021

Login to get access

Abstract

Purpose

To evaluate the safety and effectiveness of whole-liver transcatheter arterial chemoinfusion and bland embolization (TACBE) with fine-powder cisplatin and trisacryl gelatin microspheres for the treating unresectable multinodular hepatocellular carcinoma (HCC).

Materials and methods

The medical records of all patients who underwent TACBE sessions were retrospectively reviewed. 15 patients (11 men, 4 women; mean age, 72.5 years) and 22 procedures (BCLC B;17 C;5) were included in the analysis. The cisplatin resulting solution and microspheres were infused through a microcatheter placed nonselectively. Overall survival (OS) was defined as the time from commencement of initial TACBE until any cause of death. Toxicity was assessed by the CTCAE version 5.0, and the tumor response was evaluated by the mRECIST. Liver function was assessed by the albumin–bilirubin (ALBI) score.

Results

The 1-year OS rate was 64.6% (95% CI 0.438–0.955). Severe adverse effects were not observed except for grade 3 increase in the ALT, ALT, vasovagal episode. The objective response and disease control rare were 54.5% and 68.2%, respectively. The ALBI scores from pre-treatment to the follow-up ranged from − 2.39 to − 2.26 (p = 0.38).

Conclusion

Whole-liver TABCE with fine-powder cisplatin and trisacryl gelatin microspheres was well tolerated and effective in patients with multinodular HCC.
Literature
1.
go back to reference El-Serag HB, Rudolph KL. Hepatocellular carcinoma: Epidemiology and molecular carcinogenesis. Gastroenterology. 2007;132:2557–76.CrossRef El-Serag HB, Rudolph KL. Hepatocellular carcinoma: Epidemiology and molecular carcinogenesis. Gastroenterology. 2007;132:2557–76.CrossRef
2.
go back to reference Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.CrossRef Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.CrossRef
3.
go back to reference Balogh J, Victor D III, Asham EH, Burroughs SG, Boktour M, Saharia A, et al. Hepatocellular carcinoma: a review. J Hepatocell Carcinoma. 2016;3:41–53.CrossRef Balogh J, Victor D III, Asham EH, Burroughs SG, Boktour M, Saharia A, et al. Hepatocellular carcinoma: a review. J Hepatocell Carcinoma. 2016;3:41–53.CrossRef
4.
go back to reference European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69:182–236.CrossRef European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69:182–236.CrossRef
5.
go back to reference Kudo M, Arizumi T, Ueshima K, Sakurai T, Kitano M, Nishida N. Subclassification of BCLC B stage hepatocellular carcinoma and treatment strategies: proposal of modified Bolondi’s subclassification (Kinki criteria). Dig Dis. 2015;33:751–8.CrossRef Kudo M, Arizumi T, Ueshima K, Sakurai T, Kitano M, Nishida N. Subclassification of BCLC B stage hepatocellular carcinoma and treatment strategies: proposal of modified Bolondi’s subclassification (Kinki criteria). Dig Dis. 2015;33:751–8.CrossRef
6.
go back to reference Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009;10:35–43.CrossRef Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009;10:35–43.CrossRef
7.
go back to reference Arizumi T, Minami T, Chishina H, Kono M, Takita M, Yada N, et al. Time to transcatheter arterial chemoembolization refractoriness in patients with hepatocellular carcinoma in Kinki criteria stages B1 and B2. Dig Dis. 2017;35:589–97.CrossRef Arizumi T, Minami T, Chishina H, Kono M, Takita M, Yada N, et al. Time to transcatheter arterial chemoembolization refractoriness in patients with hepatocellular carcinoma in Kinki criteria stages B1 and B2. Dig Dis. 2017;35:589–97.CrossRef
8.
go back to reference Lammer J, Malagari K, Vogl T, Pilleul F, Denys A, Watkinson A, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Interv Radiol. 2010;33:41–52.CrossRef Lammer J, Malagari K, Vogl T, Pilleul F, Denys A, Watkinson A, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Interv Radiol. 2010;33:41–52.CrossRef
9.
go back to reference Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–90.CrossRef Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–90.CrossRef
10.
go back to reference Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, 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.CrossRef Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, 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.CrossRef
11.
go back to reference Kudo M, Ueshima K, Chan S, Minami T, Chishina H, Aoki T, Takita M, Hagiwara S, Minami Y, Ida H, Takenaka M. Lenvatinib as an initial treatment in patients with intermediate-stage hepatocellular carcinoma beyond up-to-seven criteria and child–pugh a liver function: a proof-of-concept study. Cancers. 2019;11:1084.CrossRef Kudo M, Ueshima K, Chan S, Minami T, Chishina H, Aoki T, Takita M, Hagiwara S, Minami Y, Ida H, Takenaka M. Lenvatinib as an initial treatment in patients with intermediate-stage hepatocellular carcinoma beyond up-to-seven criteria and child–pugh a liver function: a proof-of-concept study. Cancers. 2019;11:1084.CrossRef
12.
go back to reference Golfieri R, Giampalma E, Renzulli M, Cioni R, Bargellini I, Bartolozzi C, et al. Randomized controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. Br J Cancer. 2014;111:255–64.CrossRef Golfieri R, Giampalma E, Renzulli M, Cioni R, Bargellini I, Bartolozzi C, et al. Randomized controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. Br J Cancer. 2014;111:255–64.CrossRef
13.
go back to reference Lewis AL, Taylor RR, Hall B, Gonzalez MV, Willis SL, Stratford PW. Pharmacokinetic and safety study of doxorubicin-eluting beads in a porcine model of hepatic arterial embolization. J Vasc Interv Radiol. 2006;17:1335–43.CrossRef Lewis AL, Taylor RR, Hall B, Gonzalez MV, Willis SL, Stratford PW. Pharmacokinetic and safety study of doxorubicin-eluting beads in a porcine model of hepatic arterial embolization. J Vasc Interv Radiol. 2006;17:1335–43.CrossRef
14.
go back to reference Maluccio MA, Covey AM, Ben Porat L, Schubert J, Brody LA, Sofocleous CT, et al. Transcatheter arterial embolization with only particles for the treatment of unresectable hepatocellular carcinoma. J Vasc Interv Radiol. 2008;19:862–9.CrossRef Maluccio MA, Covey AM, Ben Porat L, Schubert J, Brody LA, Sofocleous CT, et al. Transcatheter arterial embolization with only particles for the treatment of unresectable hepatocellular carcinoma. J Vasc Interv Radiol. 2008;19:862–9.CrossRef
15.
go back to reference Malagari K, Pomoni M, Kelekis A, Pomoni A, Dourakis S, Spyridopoulos T, et al. Prospective randomized comparison of chemoembolization with doxorubicin-eluting beads and bland embolization with BeadBlock for hepatocellular carcinoma. Cardiovasc Interv Radiol. 2010;33:541–51.CrossRef Malagari K, Pomoni M, Kelekis A, Pomoni A, Dourakis S, Spyridopoulos T, et al. Prospective randomized comparison of chemoembolization with doxorubicin-eluting beads and bland embolization with BeadBlock for hepatocellular carcinoma. Cardiovasc Interv Radiol. 2010;33:541–51.CrossRef
16.
go back to reference Llovet JM, Ducreux M, Lencioni R, Di Bisceglie A, Galle P, Dufour J. European Association for the Study of the Liver, European Organization for Research and Treatment of Cancer. EASL–EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–43.CrossRef Llovet JM, Ducreux M, Lencioni R, Di Bisceglie A, Galle P, Dufour J. European Association for the Study of the Liver, European Organization for Research and Treatment of Cancer. EASL–EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–43.CrossRef
17.
go back to reference Keigo O, Yasuaki A, Hiroshi A, Yoshito T, Takeshi A, Eiji S, et al. Phase I/II multicenter study of transarterial chemoembolization with a cisplatin fine powder and porous gelatin particles for unresectable hepatocellular carcinoma: Japan Interventional Radiology in Oncology Study Group Study 0401. J Vasc Interv Radiol. 2012;23:1278–85.CrossRef Keigo O, Yasuaki A, Hiroshi A, Yoshito T, Takeshi A, Eiji S, et al. Phase I/II multicenter study of transarterial chemoembolization with a cisplatin fine powder and porous gelatin particles for unresectable hepatocellular carcinoma: Japan Interventional Radiology in Oncology Study Group Study 0401. J Vasc Interv Radiol. 2012;23:1278–85.CrossRef
18.
go back to reference Kudo M. Albumin-bilirubin grade and hepatocellular carcinoma treatment algorithm. Liver Cancer. 2017;6:185–8 (Prothrombin time).CrossRef Kudo M. Albumin-bilirubin grade and hepatocellular carcinoma treatment algorithm. Liver Cancer. 2017;6:185–8 (Prothrombin time).CrossRef
19.
go back to reference Masatoshi K, Kazuomi U, Stephan C, Tomohiro M, Hirokazu C, Tomoko A, et al. Lenvatinib as an initial treatment in patients with intermediate-stage hepatocellular carcinoma beyond up-to-seven criteria and child–pugh a liver function: a proof-of-concept study. Cancers. 2019;11:1084. https://doi.org/10.3390/cancers11081084.CrossRef Masatoshi K, Kazuomi U, Stephan C, Tomohiro M, Hirokazu C, Tomoko A, et al. Lenvatinib as an initial treatment in patients with intermediate-stage hepatocellular carcinoma beyond up-to-seven criteria and child–pugh a liver function: a proof-of-concept study. Cancers. 2019;11:1084. https://​doi.​org/​10.​3390/​cancers11081084.CrossRef
21.
go back to reference Yamashita T, Kudo M, Ikeda K, Izumi N, Tateishi R, Ikeda M, et al. REFLECT-A phase 3 trial comparing efficacy and safety of lenvatinib to sorafenib for the treatment of unresectable hepatocellular carcinoma: analysis of Japanese subset. J Gastroenterol. 2019;54:558–70.CrossRef Yamashita T, Kudo M, Ikeda K, Izumi N, Tateishi R, Ikeda M, et al. REFLECT-A phase 3 trial comparing efficacy and safety of lenvatinib to sorafenib for the treatment of unresectable hepatocellular carcinoma: analysis of Japanese subset. J Gastroenterol. 2019;54:558–70.CrossRef
22.
go back to reference Osamu M, Satoshi K, Junichiro S, Wataru K, Yasuji R, Kazuto K, et al. Hepatocelluar nodules in liver cirrhosis: hemodynamic evaluation (angiographyassisted CT) with special reference to multi-step hepatocarcinogenesis. Abdom Imaging. 2011;36:264–72.CrossRef Osamu M, Satoshi K, Junichiro S, Wataru K, Yasuji R, Kazuto K, et al. Hepatocelluar nodules in liver cirrhosis: hemodynamic evaluation (angiographyassisted CT) with special reference to multi-step hepatocarcinogenesis. Abdom Imaging. 2011;36:264–72.CrossRef
Metadata
Title
Whole-liver transcatheter arterial chemoinfusion and bland embolization with fine-powder cisplatin and trisacryl gelatin microspheres for treating unresectable multiple hepatocellular carcinoma
Authors
Akihiro Imamura
Hidetoshi Taguchi
Hideyuki Takano
Hiroyuki Funatsu
Kazuyoshi Nakamura
Hidehito Arimitsu
Satoshi Chiba
Publication date
01-05-2021
Publisher
Springer Singapore
Published in
Japanese Journal of Radiology / Issue 5/2021
Print ISSN: 1867-1071
Electronic ISSN: 1867-108X
DOI
https://doi.org/10.1007/s11604-020-01078-1

Other articles of this Issue 5/2021

Japanese Journal of Radiology 5/2021 Go to the issue