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Single center experience with the Surefire Infusion System for Delivery of DEB-TACE in treatment of HCC
JVIR
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Scientific Session
Tuesday
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S129
performed using drug-eluting beads (DC-Beads M1) loaded with doxorubicin (DEBDOX procedure). Two DEBDOX procedures at an interval of one month were scheduled for each patient. The tumor responses were evaluated by MRI every three month after the first procedure until progression. Adverse events were recorded according to the Common Terminology Criteria for Adverse Events (CTCAE version 4.02). Patients with hormone-positive receptor disease continued using hormonotherapy; otherwise, all patients were free of systemic chemotherapy until progression. Results: Seventeen of the 23 patients (mean age: 57.5 ±11.5 years) completed two DEBDOX procedures and six underwent only one due to severe advert events or intolerance. At the 3-month follow-up, six (26%) patients showed a partial response (PR), 13 (57%) had stable disease (SD) and four (17%) showed progressive disease (PD). The median time to progression from the first DEBDOX procedure was 8 months and median overall survival 17 months. Nineteen patients remained free of any systemic chemotherapy for a mean of 209±92 days until progression. Twelve severe adverse events (Grade 3) occurred after the first procedure and two after the second procedure. No patient died directly due to the procedure. Conclusions: The DEBDOX procedure appears to be safe and effective for treatment-refractory liver metastasis associated with breast cancer.
drug eluting beads with 50mg of Doxorubicin. All patients treated with SIS were alive at the time of evaluation. Follow up imaging was available for six patients with 15 lesions. After initial treatment with SIS, 12 of 15 (80%) of the lesions had complete response (CR), 2 of 15 (13%) demonstrated partial response (PR), and 1 lesion had stable disease (SD) The lesion with SD was demonstrated to have a phrenic artery supply on repeat angiogram and was subsequently treated with an endhole catheter. One patient with an initial PR was re-treated with the SIS. He underwent transplantation prior to his follow up imaging but was found to have 100% necrosis on explants pathology. The third patient with PR has undergone repeat treatment and is awaiting follow up imaging. Five and six patients were BCLC stage A and B respectively at the time of their treatment with SIS. 3 of 6 BCLC B patients had follow up imaging available at the time of evaluation. All four were successfully downstaged to within Milan criteria with 2 pts having CR of their 8 lesions. The third patient had PR of the larger lesions, with the enhancing nodule decreasing in size from 8.4 x 7.6 cm to 4.1 x 2.9 cm and CR in the 2nd lesion. Conclusions: SIS is a promising tool for delivery of DEBTACE in treatment of HCC and may lead to improved disease response when compared with delivery with standard end-hole catheters. A prospective trial is planned to validate our findings.
References
4:12 PM
4:03 PM
Abstract No. 283
Single center experience with the Surefire Infusion System for Delivery of DEB-TACE in treatment of HCC A. Kim1, G. Lynskey2, T. Caridi1, D. Buckley3; 1 Georgetown University Hospital, Washington, DC; 2 Georgetown University Hospital, Arlington, VA; 3 Gaithersburg, MD. Purpose: The purpose of this study was to evaluate the efficacy of the Surefire Infusion System (SIS) for delivery of DEB-TACE in treatment of HCC. Materials: A retrospective review was performed of all patients who underwent DEB-TACE for the treatment of HCC with the SIS in a 12-month period. Patient outcomes were assessed based on modified Response Evaluation Criteria in Solid Tumors (mRECIST) on follow up imaging. Results: Eleven patients with 21 separate HCC lesions underwent 12 DEB-TACE treatments utilizing the SIS for delivery. 17 lesions were previously treated using a standard end-hole catheter. All lesions were treated with various size
Abstract No. 284
Chemoembolization of hepatocellular carcinoma with segmental portal vein tumor thrombus J. Choi1, H. Kim2, W. Choi3, J. Chung2, J. Park4; 1Seoul National University, Seoul, Republic of Korea; 2Seoul National University Hospital, Seoul, Republic of Korea; 3 Seoul National Univertiy, Seoul, Republic of Korea; 4 Myungji Hospital, Goyang-si, gyeonggi-do, Republic of Korea. Purpose: To evaluate the clinical outcome and safety of chemoembolization for hepatocellular carcinoma (HCC) with (sub)segmental portal vein tumor thrombus (sPVTT) in patients with preserved hepatic function, and to address the efficacy of additional chemoinfusion after chemoembolization. Materials: The institutional review board approved this retrospective study. From January 2003 to December 2012, chemoembolization was conducted on 81 patients with ChildPugh score 7 who had HCC with sPVTT. Thirty-one of them underwent additional, transarterial chemoinfusion after chemoembolization. The overall survival (OS) and serious adverse events (SAEs) were evaluated. The efficacy of additional chemoinfusion was appraised after adjustment with inverse probability of treatment weighting (IPTW). Results: The OS after chemoembolization (median, 15.5 months) was significantly related with aspartate aminotransferase (p o .001; hazard ratio [HR], 1.011), modified Barcelona Clinic Liver Cancer (BCLC) stage D (p ¼ .038; HR, 2.841), extrahepatic spread (p o .001; HR, 4.862), and additional chemoinfusion (p ¼ .002; HR, .367). The occurrence of SAEs (incidence, 23.5% [19/81]) was significantly associated with modified BCLC stages (proper-C; p ¼ .004; HR, 10.174) (D; p ¼ .003; HR, 24.000). After IPTW adjustment, additional chemoinfusion after
TUESDAY: Scientific Sessions
1. Talay G, Biganzoli L, Renard F, Paridaens R, Cufer T, Coleman R et al. Clinical outcome of breast cancer patients with liver metastases alone in the anthracycline-taxane era: a retrospective analysis of two prospective, randomised metastatic breast cancer trials. Eur J Cancer 2003;39:2439-2449. 2. Giroux MF, Baum RA, Soulen MC. Chemoembolization of liver metastasis from breast carcinoma. J Vasc Interv Radiol 2004;15:289-291. 3. Martin RC, Robbins K, Fages JF, Romero FD, Rustein L, Tomalty D et al. Optimal outcomes for liver-dominant metastatic breast cancer with transarterial chemoembolization with drug-eluting beads loaded with doxorubicin. Breast Cancer Res Treat 2012;132(2):753-763. http://dx.doi. org/10.1007/s10549-011-1926-z.
’
Scientific Session
Tuesday
’
S129
performed using drug-eluting beads (DC-Beads M1) loaded with doxorubicin (DEBDOX procedure). Two DEBDOX procedures at an interval of one month were scheduled for each patient. The tumor responses were evaluated by MRI every three month after the first procedure until progression. Adverse events were recorded according to the Common Terminology Criteria for Adverse Events (CTCAE version 4.02). Patients with hormone-positive receptor disease continued using hormonotherapy; otherwise, all patients were free of systemic chemotherapy until progression. Results: Seventeen of the 23 patients (mean age: 57.5 ±11.5 years) completed two DEBDOX procedures and six underwent only one due to severe advert events or intolerance. At the 3-month follow-up, six (26%) patients showed a partial response (PR), 13 (57%) had stable disease (SD) and four (17%) showed progressive disease (PD). The median time to progression from the first DEBDOX procedure was 8 months and median overall survival 17 months. Nineteen patients remained free of any systemic chemotherapy for a mean of 209±92 days until progression. Twelve severe adverse events (Grade 3) occurred after the first procedure and two after the second procedure. No patient died directly due to the procedure. Conclusions: The DEBDOX procedure appears to be safe and effective for treatment-refractory liver metastasis associated with breast cancer.
drug eluting beads with 50mg of Doxorubicin. All patients treated with SIS were alive at the time of evaluation. Follow up imaging was available for six patients with 15 lesions. After initial treatment with SIS, 12 of 15 (80%) of the lesions had complete response (CR), 2 of 15 (13%) demonstrated partial response (PR), and 1 lesion had stable disease (SD) The lesion with SD was demonstrated to have a phrenic artery supply on repeat angiogram and was subsequently treated with an endhole catheter. One patient with an initial PR was re-treated with the SIS. He underwent transplantation prior to his follow up imaging but was found to have 100% necrosis on explants pathology. The third patient with PR has undergone repeat treatment and is awaiting follow up imaging. Five and six patients were BCLC stage A and B respectively at the time of their treatment with SIS. 3 of 6 BCLC B patients had follow up imaging available at the time of evaluation. All four were successfully downstaged to within Milan criteria with 2 pts having CR of their 8 lesions. The third patient had PR of the larger lesions, with the enhancing nodule decreasing in size from 8.4 x 7.6 cm to 4.1 x 2.9 cm and CR in the 2nd lesion. Conclusions: SIS is a promising tool for delivery of DEBTACE in treatment of HCC and may lead to improved disease response when compared with delivery with standard end-hole catheters. A prospective trial is planned to validate our findings.
References
4:12 PM
4:03 PM
Abstract No. 283
Single center experience with the Surefire Infusion System for Delivery of DEB-TACE in treatment of HCC A. Kim1, G. Lynskey2, T. Caridi1, D. Buckley3; 1 Georgetown University Hospital, Washington, DC; 2 Georgetown University Hospital, Arlington, VA; 3 Gaithersburg, MD. Purpose: The purpose of this study was to evaluate the efficacy of the Surefire Infusion System (SIS) for delivery of DEB-TACE in treatment of HCC. Materials: A retrospective review was performed of all patients who underwent DEB-TACE for the treatment of HCC with the SIS in a 12-month period. Patient outcomes were assessed based on modified Response Evaluation Criteria in Solid Tumors (mRECIST) on follow up imaging. Results: Eleven patients with 21 separate HCC lesions underwent 12 DEB-TACE treatments utilizing the SIS for delivery. 17 lesions were previously treated using a standard end-hole catheter. All lesions were treated with various size
Abstract No. 284
Chemoembolization of hepatocellular carcinoma with segmental portal vein tumor thrombus J. Choi1, H. Kim2, W. Choi3, J. Chung2, J. Park4; 1Seoul National University, Seoul, Republic of Korea; 2Seoul National University Hospital, Seoul, Republic of Korea; 3 Seoul National Univertiy, Seoul, Republic of Korea; 4 Myungji Hospital, Goyang-si, gyeonggi-do, Republic of Korea. Purpose: To evaluate the clinical outcome and safety of chemoembolization for hepatocellular carcinoma (HCC) with (sub)segmental portal vein tumor thrombus (sPVTT) in patients with preserved hepatic function, and to address the efficacy of additional chemoinfusion after chemoembolization. Materials: The institutional review board approved this retrospective study. From January 2003 to December 2012, chemoembolization was conducted on 81 patients with ChildPugh score 7 who had HCC with sPVTT. Thirty-one of them underwent additional, transarterial chemoinfusion after chemoembolization. The overall survival (OS) and serious adverse events (SAEs) were evaluated. The efficacy of additional chemoinfusion was appraised after adjustment with inverse probability of treatment weighting (IPTW). Results: The OS after chemoembolization (median, 15.5 months) was significantly related with aspartate aminotransferase (p o .001; hazard ratio [HR], 1.011), modified Barcelona Clinic Liver Cancer (BCLC) stage D (p ¼ .038; HR, 2.841), extrahepatic spread (p o .001; HR, 4.862), and additional chemoinfusion (p ¼ .002; HR, .367). The occurrence of SAEs (incidence, 23.5% [19/81]) was significantly associated with modified BCLC stages (proper-C; p ¼ .004; HR, 10.174) (D; p ¼ .003; HR, 24.000). After IPTW adjustment, additional chemoinfusion after
TUESDAY: Scientific Sessions
1. Talay G, Biganzoli L, Renard F, Paridaens R, Cufer T, Coleman R et al. Clinical outcome of breast cancer patients with liver metastases alone in the anthracycline-taxane era: a retrospective analysis of two prospective, randomised metastatic breast cancer trials. Eur J Cancer 2003;39:2439-2449. 2. Giroux MF, Baum RA, Soulen MC. Chemoembolization of liver metastasis from breast carcinoma. J Vasc Interv Radiol 2004;15:289-291. 3. Martin RC, Robbins K, Fages JF, Romero FD, Rustein L, Tomalty D et al. Optimal outcomes for liver-dominant metastatic breast cancer with transarterial chemoembolization with drug-eluting beads loaded with doxorubicin. Breast Cancer Res Treat 2012;132(2):753-763. http://dx.doi. org/10.1007/s10549-011-1926-z.