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P991 CHEMOEMBOLIZATION OF HEPATOCELLULAR CARCINOMA WITH M1 DRUG ELUTING BEADS: SAFETY AND EFFECTIVENESS
POSTERS P990 RISK OF TUMOR SEEDING DOES NOT INCREASE BY LIVER BIOPSY FOR HEPATOCELLULAR CARCINOMA PERFORMED DURING RADIOFREQUENCY ABLATION S.Y. Park1 , W.Y. Tak1 , Y.O. Kweon1 , S.Y. Jang1 , J.G. Park2 , S.Y. Ahn1 , E.J. Kang1 , J. Heo3 , H.Y. Woo3 . 1 Gastroenterology, Kyungpook National University Hospital, Daegu, 2 Gastroenterology, CHA Gumi Medical Center, Gumi, 3 Pusan National University Hospital, Pusan, Korea, Republic of E-mail: [email protected] Background and Aims: Although pathologic diagnosis of hepatocellular carcinoma (HCC) provides important information on accurate diagnosis, differentiation and prognosis of HCC, liver biopsy is not performed widely because procedure might be associated with tumor seedidng during percutaneous ablative procedure. The present study aimed to assess the incidence, risk factors, and prognosis of tumor seeding after liver biopsy during radiofrequency ablation (RFA) for HCC. Methods: From January 2009 to December 2012, 955 patients underwent treatment with RFA for HCC in Kyungpook National University Hospital. Two hundred eighty seven patients underwent percutaneous liver biopsy during RFA procedure. The biopsy was performed by coaxial technique using guiding catheter through which automated biopsy needle and RFA electrodes were passed. The risk and pattern of tumor recurrence in patients who underwent biopsy were assessed and compared to the group of patients who do not have significantly difference in tumor size and number. Results: There were no significant differences in baseline characteristics between two groups. There were 2 cases of tumor seeding in RFA electrode tract in each group. The rate of tumor recurrence was 36.2% (104 patients) in biopsy group and 39.8% (96 patients) in non-biopsy group (p = 0.418). The risk of local recurrence was not significantly different between two groups (15.7% in biopsy group vs. 13.1% in non-biopsy group, p = 0.485). The risk factor associated with tumor recurrence were identified as the number of tumor (OR 1.736, CI 1.148–2.625, p = 0.009). Conclusions: Percutaneous liver biopsy of HCC by coaxial technique does not increase the risk of tumor seeding in patients undergoing RFA. P991 CHEMOEMBOLIZATION OF HEPATOCELLULAR CARCINOMA WITH M1 DRUG ELUTING BEADS: SAFETY AND EFFECTIVENESS M. Triolo1 , M. Iavarone1 , A. Nicolini2 , S. Crespi2 , A. Sangiovanni1 , M. Colombo1 . 1 1st Division of Gastroenterology, 2 Division of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Universit` a degli Studi di Milano, Milan, Italy E-mail: [email protected] Background and Aims: Transarterial chemoembolization (TACE) is the SOC treatment for unresectable hepatocellular carcinoma (HCC). We assessed the safety and efficacy of TACE using 70– 150 mm drug eluting beads (DC-BeadM1-TACE, Biocompatibles UK), an embolizing device which avoids premature proximal occlusion of tumor-feeding vessels and increases drug delivery to the tumor. Methods: All patients consecutively submitted to DC-BeadM1-TACE with least one sizable and untreated nodule of HCC detectable at baseline CT-scan, were studied. Clinical and analytical data were recorded at 24 and 48 h, 7, 14 and 30 days after first TACE. Blood samples were obtained in 17 patients to determine epirubicin Cmax and AUC. Response was assessed by CT-scan after one month according to modified RECIST (mRECIST). In patients achieving a complete response (CR) to treatment, a new CT-scan was done after three months. Patients failing a CR, received a second DCBeadM1-TACE.
Results: Fifty-seven cirrhotics (81% male, 72 years, 68% HCV, 76% Child–Pugh A) with unresectable HCC (24% BCLC A4 and 35% BCLC B) were treated. No major complications occurred, 26% had abdominal pain after 20 minutes to 3 hours following the procedure, 7% transient hypertension and 9% post TACE syndrome with slight modifications of liver function parameters. After 1 month, 24% had CR, 56% partial response, 11% stable disease and 9% progression. AFP dropped from 362 to 222 ng/mL. CT-scan after 3 months was available in 9/13 patients who achieved a complete response, 46% maintained CR. Conclusions: DC-BeadM1-TACE is effective and safe, causing objective response in a majority of the patients. P992 FIRST-LINE TREATMENT OF 90 CONSECUTIVE HCC WITH DRUG ELUTING BEADS CHEMOEMBOLIZATION (DEB-TACE) M. Triolo, A. Sangiovanni, A. Nicolini, M. Iavarone, S. Crespi, M.A. Manini, C. Della Corte, S. Vavassori, M. Colombo. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy E-mail: [email protected] Background and Aims: Aim was to evaluate the application of drug eluting beads chemoembolization (DEB-TACE) as first-line treatment of HCC in a consecutive series of cirrhotic patients discussed by a multidisciplinary clinic (MDC) team in a single tertially centre. Methods: Out of 383 consecutive patients with a de-novo HCC observed between January 2007 and December 2011, 90 (23%) not suitable for liver transplantation were proposed for DEB-TACE: 65 (72%) males, mean age 68 (range 47–76), 63 (70%) Child–Pugh A, 44 (49%) BCLC A, 37 (41%) BCLC B, 9 (10%) BCLC C. DEBTACE was repeated every two months until complete response or progression, assessed by CT-scan, according to modified RECIST criteria. Recurrent HCCs and progressive disease were further treated according to MDC decision. Discrepancies to AASLD/EASLEORTC recommendations were recorded. Results: During 41 months (range 6–142), 30 (33%) patients died. Complete response was reported in 19 (21%). Overall yearly mortality rate was 12%, corresponding to 1, 3, 5 yr survival 92%, 81%, 57%. These figures were 6%, 98%, 84%, 71% in BCLC A; 17%, 94%, 54%, 42% in BCLC B; 57%, 60%, 14%, 0% in BCLC C, respectively. Independent predictors of survival were number of nodules HR 1.14 (95 CI 1.1–1.2, p < 0.001), AFP >200 ng/mL HR 1.95 (95% CI 1.5–2.5, p < 0.001) and ascites HR 2.16 (95% CI 1.4–3.4, p = 0.001). Conclusions: First-line treatment with DEB-TACE achieved 71% 5yr survival in BCLC A, comparable to radical therapies and it can be safely applied to advanced HCCs with peripheral neoplastic portal thrombosis without extrahepatic spread. P993 EASL AND MRECIST RESPONSE TO COMBINATION THERAPY OF SORAFENIB AND TRANSARTERIAL CHEMOEMBOLIZATION PREDICTS SURVIVAL IN HEPATOCELLULAR CARCINOMA W. Wang, W. Bai, Y. Zhao, Z. Yin, C. He, J. Niu, L. Liu, H. Chen, D. Fan, G. Han. Dept. of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China E-mail: [email protected] Background and Aims: There was no study investigating the use of RECIST, EASL and mRECIST for assessing treatment response to combination therapy of sorafenib and transarterial chemoembolization in patients with hepatocellular carcinoma (HCC). The aim of this study was to explore the earliest time point for accurate assessment of response to combination therapy in HCC patients, as well as to compare the three criteria and to validate the prognostic value of them when applied at this early time point post-therapy.
Journal of Hepatology 2014 vol. 60 | S361–S522
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Results: Fifty-seven cirrhotics (81% male, 72 years, 68% HCV, 76% Child–Pugh A) with unresectable HCC (24% BCLC A4 and 35% BCLC B) were treated. No major complications occurred, 26% had abdominal pain after 20 minutes to 3 hours following the procedure, 7% transient hypertension and 9% post TACE syndrome with slight modifications of liver function parameters. After 1 month, 24% had CR, 56% partial response, 11% stable disease and 9% progression. AFP dropped from 362 to 222 ng/mL. CT-scan after 3 months was available in 9/13 patients who achieved a complete response, 46% maintained CR. Conclusions: DC-BeadM1-TACE is effective and safe, causing objective response in a majority of the patients. P992 FIRST-LINE TREATMENT OF 90 CONSECUTIVE HCC WITH DRUG ELUTING BEADS CHEMOEMBOLIZATION (DEB-TACE) M. Triolo, A. Sangiovanni, A. Nicolini, M. Iavarone, S. Crespi, M.A. Manini, C. Della Corte, S. Vavassori, M. Colombo. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy E-mail: [email protected] Background and Aims: Aim was to evaluate the application of drug eluting beads chemoembolization (DEB-TACE) as first-line treatment of HCC in a consecutive series of cirrhotic patients discussed by a multidisciplinary clinic (MDC) team in a single tertially centre. Methods: Out of 383 consecutive patients with a de-novo HCC observed between January 2007 and December 2011, 90 (23%) not suitable for liver transplantation were proposed for DEB-TACE: 65 (72%) males, mean age 68 (range 47–76), 63 (70%) Child–Pugh A, 44 (49%) BCLC A, 37 (41%) BCLC B, 9 (10%) BCLC C. DEBTACE was repeated every two months until complete response or progression, assessed by CT-scan, according to modified RECIST criteria. Recurrent HCCs and progressive disease were further treated according to MDC decision. Discrepancies to AASLD/EASLEORTC recommendations were recorded. Results: During 41 months (range 6–142), 30 (33%) patients died. Complete response was reported in 19 (21%). Overall yearly mortality rate was 12%, corresponding to 1, 3, 5 yr survival 92%, 81%, 57%. These figures were 6%, 98%, 84%, 71% in BCLC A; 17%, 94%, 54%, 42% in BCLC B; 57%, 60%, 14%, 0% in BCLC C, respectively. Independent predictors of survival were number of nodules HR 1.14 (95 CI 1.1–1.2, p < 0.001), AFP >200 ng/mL HR 1.95 (95% CI 1.5–2.5, p < 0.001) and ascites HR 2.16 (95% CI 1.4–3.4, p = 0.001). Conclusions: First-line treatment with DEB-TACE achieved 71% 5yr survival in BCLC A, comparable to radical therapies and it can be safely applied to advanced HCCs with peripheral neoplastic portal thrombosis without extrahepatic spread. P993 EASL AND MRECIST RESPONSE TO COMBINATION THERAPY OF SORAFENIB AND TRANSARTERIAL CHEMOEMBOLIZATION PREDICTS SURVIVAL IN HEPATOCELLULAR CARCINOMA W. Wang, W. Bai, Y. Zhao, Z. Yin, C. He, J. Niu, L. Liu, H. Chen, D. Fan, G. Han. Dept. of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China E-mail: [email protected] Background and Aims: There was no study investigating the use of RECIST, EASL and mRECIST for assessing treatment response to combination therapy of sorafenib and transarterial chemoembolization in patients with hepatocellular carcinoma (HCC). The aim of this study was to explore the earliest time point for accurate assessment of response to combination therapy in HCC patients, as well as to compare the three criteria and to validate the prognostic value of them when applied at this early time point post-therapy.
Journal of Hepatology 2014 vol. 60 | S361–S522
S405