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12.09.2018 | Original Article

Transarterial radioembolization in patients with hepatocellular carcinoma of intermediate B2 substage

Zeitschrift:
European Journal of Nuclear Medicine and Molecular Imaging
Autoren:
Alberta Cappelli, Paloma Sangro, Cristina Mosconi, Iris Deppe, Eleonora Terzi, Jose I. Bilbao, Macarena Rodriguez-Fraile, Caterina De Benedittis, Jens Ricke, Rita Golfieri, Bruno Sangro
Wichtige Hinweise
Alberta Cappelli and Paloma Sangro were joint lead authors.

Key points

1. Intermediate stage BCLC-B HCC includes a heterogeneous group of patients with different degrees of liver function impairment and tumour burden in whom the recommended treatment is transarterial chemoembolization (TACE).
2. Patients with BCLC-B stage HCC are sometimes poor candidates for TACE, and transarterial radioembolization (TARE) is then an option in multidisciplinary team discussions.
3. Experts have proposed a subclassification of stage BCLC-B into four substages on the basis of the degree of liver function impairment, tumour burden and performance status.
4. Patients with BCLC-B2 substage HCC with a large tumour could benefit more from TARE treatment.

Abstract

Purpose

Patients with hepatocellular carcinoma (HCC) of intermediate stage (BCLC-B according to the Barcelona Clinic Liver Cancer classification) are a heterogeneous group with different degrees of liver function impairment and tumour burden. The recommended treatment is transarterial chemoembolization (TACE). However, patients in this group may be judged as poor candidates for TACE because the risk-benefit ratio is low. Such patients may receive transarterial radioembolization (TARE) only by entering a clinical trial. Experts have proposed that the stage could be further divided into four substages based on available evidence of treatment benefit. We report here, for the first time, the outcome in patients with BCLC-B2 substage HCC treated with TARE.

Methods

A retrospective analysis of the survival of 126 patients with BCLC-B2 substage HCC treated with TARE in three European hospitals was performed.

Results

Overall median survival in patients with BCLC-B2 substage was not significantly different in relation to tumour characteristics; 19.35 months (95% CI 8.27–30.42 months) in patients with a single large (>7 cm) HCC, and 18.43 months (95% CI 15.08–21.77 months) in patients with multinodular HCC (p = 0.27). However, there was a higher proportion of long-term survivors at 36 months among those with a single large tumour (29%) than among those with multiple tumours (16.8%).

Conclusion

Given the poor efficacy of TACE in treating patients with BCLC-B2 substage HCC, TARE treatment could be a better choice, especially in those with a large tumour.

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