Conventional transarterial chemoembolization versus drug-eluting bead transarterial chemoembolization for the treatment of hepatocellular carcinoma.

Background: To compare the overall survival of patients with hepatocellular carcinoma (HCC) who were treated with lipiodol-based conventional transarterial chemoembolization (cTACE) with that of patients treated with drug-eluting bead transarterial chemoembolization (DEB-TACE).

Methods: By an electronic search of our radiology information system, we identified 674 patients that received TACE between November 2002 and July 2013. A total of 520 patients received cTACE, and 154 received DEB-TACE. In total, 424 patients were excluded for the following reasons: tumor type other than HCC (n=91), liver transplantation after TACE (n=119), lack of histological grading (n=58), incomplete laboratory values (n=15), other reasons (e.g., previous systemic chemotherapy) (n=114), or were lost to follow-up (n=27). Therefore, 250 patients were finally included for comparative analysis (n=174 cTACE; n=76 DEB-TACE).

Results: There were no significant differences between the two groups regarding sex, overall status (Barcelona Clinic Liver Cancer classification), liver function (Child-Pugh), portal invasion, tumor load, or tumor grading (all p>0.05). The mean number of treatment sessions was 4±3.1 in the cTACE group versus 2.9±1.8 in the DEB-TACE group (p=0.01). Median survival was 409 days (95% CI: 321-488 days) in the cTACE group, compared with 369 days (95% CI: 310-589 days) in the DEB-TACE group (p=0.76). In the subgroup of Child A patients, the survival was 602 days (484-792 days) for cTACE versus 627 days (364-788 days) for DEB-TACE (p=0.39). In Child B/C patients, the survival was considerably lower: 223 days (165-315 days) for cTACE versus 226 days (114-335 days) for DEB-TACE (p=0.53).

Conclusion: The present study showed no significant difference in overall survival between cTACE and DEB-TACE in patients with HCC. However, the significantly lower number of treatments needed in the DEB-TACE group makes it a more appealing treatment option than cTACE for appropriately selected patients with unresectable HCC.