13th Annual Global Embolization Symposium & Technologies
Purpose : To evaluate TACE treatments for HCC patients in a real world setting with BCLC Stages A-D with attention based upon the size of the target lesion upon presentation.
Material and Methods : Retrospective review of off-labeled use of 75 mg doxorubicin-loaded DEB-TACE with 40μM Oncozene used in two institutions in San Antonio; 2-yr study included all patients with varying stages of BCLC and varying tumor sizes. Kaplan Meier Survivability curves with Fischer's exact test to determine the P values in addition to mRECIST Best Response to Treatment.
Results : A total of 95 pts was included in the study and all received DEB-TACE. There were 55(58%) BCLC Stage A&B and 40(42%) Stage C&D. Pts with targeted tumor lengths included 41(43%) <3cm, 30(32%) 3-5cm and 24(25%) >5cm. Kaplan Meier Curves showed 1-yr survival of all deaths to be 95%, 79% and 60% for tumor sizes <3cm, 3-5cm and >5cm, respectively. At 2-yrs, these fell to 83%, 47% and 35%, respectively (statistically significant). Subdivided into BCLC categories for yr-1 and yr-2, the A&B pts with tumors <3 cm had survivability 100% and 85%, those with tumors 3-5cm had 92% and 79%, and those >5cm had 75% and 63%, respectively (not statistically significant). The C&D pts with tumors < 3 cm had survivability 89% and 65%, those with tumors 3-5cm had 77% and 39%, and those >5cm had 44% and 33%, respectively (statistically significant). Additionally, we found the mRECIST Best Response to Treatment based upon size to have Objective Response (CR and PR) of 71% for tumors < 3cm, 73% for tumors 3-5 cm and 65% for those >5cm (not statistically significant). Based upon the BCLC categories and size, the ranges of CR for A&B was 67-83% depending on size versus C&D of 38-64%.
Conclusions : We studied the variable size of the targeted tumor on presentation. Those with tumors under 3cm did well. Those with 3-5cm did well the 1st year but poorly the 2nd, and those with tumors>5cm badly. In terms of overall survivability: size really matters. With the BCLC included, this demonstrated no significant difference in treating the A&B patients, but a real difference in treating the C&D patients. Surprisingly, mRECIST did not seem to matter with tumor size. More work is needed in this field.