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Tumor grade and primary treatment response following DEB-TACE for hepatocellular carcinoma based on liver explant
JVIR
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Scientific Session
Tuesday
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S125
Pugh A patients and Barcelona Clinic Liver Cancer (BCLC) stages A and B patients together constituted 69% and 84% of the patient population respectively. Overall tumor response was 23% complete response, 66% objective response and 90% disease control. Complete response, objective response and disease control were 27%, 64% and 89% respectively in Child-Pugh A patients, and 27%, 72% and 92% respectively in BCLC stages A and B patients. Complete response, objective response and disease control were 15%, 71% and 91% respectively in Child-Pugh B and C patients, and 16%, 55% and 87% respectively in BCLC stages C and D patients. We did not observe a statistically significant difference across CHILD or BCLC staging. Grades 3 toxicity was seen in 10% of the patients. There was only 1 patient with grade 4 toxicity recorded. The 6, 12 and 18 month survival were 97%, 84% and 72% respectively. Conclusions: The present study shows very good tumor response rate and survival outcomes for TACE using 75 microns Oncozene DEB, with very low toxicity profile.
explant between patients with CR/PR vs SD (11% vs 41%, p ¼ 0.004). Conclusions: Unfavorable primary treatment response was associated with higher grade tumors and the presence of lymphovascular invasion, poorer predictors of success following liver transplant. These findings suggest that poor response may be associated with unfavorable tumor features, and patients may benefit from additional forms of locoregional therapy following a poor primary response to DEB-TACE.
3:45 PM
Purpose: Given that the bile duct and gallbladder supply is from the hepatic arterial tree, arterial embolotherapies can result in biliary strictures, bilomas, or cholecystitis. Biliary complications have been well-reported with TACE, with a reported incidence of up to 33% after DEB-TACE. Acute cholecystitis has been reported in 5% of patients after TACE. The incidence of hepatic abscess formation after TACE is highest in the setting of an incompetent sphincter of Oddi, with a reported incidence of up to 86%. However, there is a lack of literature on these complications after bland embolization. The purpose of this study was to assess the incidence of biliary complications, cholecystitis, and abscess formation in HCC patients following bland embolization. Materials: Retrospective review of HCC patients treated with bland embolization over a 10-year period revealed 384 procedures in 212 patients. Embolization was performed with particles mixed with antibiotics in addition to IV antibiotics. All follow-up imaging after treatment were retrospectively reviewed for the development of bilomas, biliary dilation, biliary strictures, acute cholecystitis, and hepatic abscess. Clinic notes and laboratory tests were also reviewed. Results: Mean follow up duration was 18.2 months. In total, there was one biliary complication consisting of biloma formation. This patient had subsegmental hepatic infarction identified on imaging 8 days post embolization in the setting of subsegmental portal vein thrombus, with subsequent biloma development. There were no cases of new biliary dilation or strictures in the embolized portion of the liver at any point after treatment. One patient developed acute gangrenous cholecystitis 10 days post procedure. No patients developed a hepatic abscess, although 18 patients had an incompetent sphincter of Oddi. Conclusions: Biliary complications and cholecystitis occurred extremely rarely after bland embolization, at a markedly lower rate than historical data on TACE. Despite an incompetent sphincter in 18 patients, bland embolization with particles mixed with antibiotics resulted in zero abscesses, in contrast to a very high rate after TACE in the literature.
Abstract No. 288
Tumor grade and primary treatment response following DEB-TACE for hepatocellular carcinoma based on liver explant T. Sandow, A. Albar, P. Gulotta, G. Bennett, G. Galliano, D. DeVun, D. Kirsch, J. Gimenez, D. Malkerneker, P. Gilbert, H. Bohorquez, D. Kay; Ochsner Clinic Foundation, New Orleans, LA
Abstract No. 289
Biliary complications and abscess formation after bland embolization for the treatment of HCC Q. Wang1, J. Ronald2, M. Hall2, P. Suhocki2, C. Kim2; 1 Duke Univ / Huazhong University of Science and Technology, Durham, NC; 2Duke University Medical Center, Durham, NC
TUESDAY: Scientific Sessions
Purpose: Transarterial chemoembolization with drug-eluting beads (DEB-TACE) has demonstrated efficacy in downstaging or bridging HCC patients to transplant. The purpose of this study is to identify tumor characteristics based on primary treatment response with explant pathology for confirmation. Materials: A retrospective analysis was performed on all patients who were treated for HCC with DEB-TACE (100-300m LC Beads™ mixed with 50-75mg doxorubicin) and subsequently transplanted, which included 105 patients. Of these 105 patients, 93 had post-treatment imaging with triple phase CT or MRI prior to transplantation. Primary treatment response was based on modified RECIST criteria at the time of one month follow-up imaging. HCC was confirmed on explant in 84 patients, as 9 patients demonstrated complete tumor necrosis, prohibiting tumor grade classification. Tumor grade and lymphovascular invasion were included in the pathologic findings and compared to the primary treatment response. Results: Of the 84 patients, lower grade tumors were noted in 75 patients (G1, n ¼ 11; G2, n ¼ 64), and 9 were poorly differentiated (G3, n ¼ 6; G4, n ¼ 3). Low grade tumors showed favorable treatment response in 83% (CR,38%; PR,45%; SD,17%), as opposed to poorly differentiated tumors (CR,0%; PR,11%, SD,89%), po0.0001. Lymphovascular invasion was present in 15% of lower grade tumors as opposed to 67% of higher grade tumors (p ¼ 0.001). Similarly, patients with a favorable treatment response (CR or PR) on imaging were more likely to be G1/G2 as opposed to G3/G4 (98% vs 2%, po0.0001). Treatment response also correlated with the presence of lymphovascular invasion on
3:54 PM
’
Scientific Session
Tuesday
’
S125
Pugh A patients and Barcelona Clinic Liver Cancer (BCLC) stages A and B patients together constituted 69% and 84% of the patient population respectively. Overall tumor response was 23% complete response, 66% objective response and 90% disease control. Complete response, objective response and disease control were 27%, 64% and 89% respectively in Child-Pugh A patients, and 27%, 72% and 92% respectively in BCLC stages A and B patients. Complete response, objective response and disease control were 15%, 71% and 91% respectively in Child-Pugh B and C patients, and 16%, 55% and 87% respectively in BCLC stages C and D patients. We did not observe a statistically significant difference across CHILD or BCLC staging. Grades 3 toxicity was seen in 10% of the patients. There was only 1 patient with grade 4 toxicity recorded. The 6, 12 and 18 month survival were 97%, 84% and 72% respectively. Conclusions: The present study shows very good tumor response rate and survival outcomes for TACE using 75 microns Oncozene DEB, with very low toxicity profile.
explant between patients with CR/PR vs SD (11% vs 41%, p ¼ 0.004). Conclusions: Unfavorable primary treatment response was associated with higher grade tumors and the presence of lymphovascular invasion, poorer predictors of success following liver transplant. These findings suggest that poor response may be associated with unfavorable tumor features, and patients may benefit from additional forms of locoregional therapy following a poor primary response to DEB-TACE.
3:45 PM
Purpose: Given that the bile duct and gallbladder supply is from the hepatic arterial tree, arterial embolotherapies can result in biliary strictures, bilomas, or cholecystitis. Biliary complications have been well-reported with TACE, with a reported incidence of up to 33% after DEB-TACE. Acute cholecystitis has been reported in 5% of patients after TACE. The incidence of hepatic abscess formation after TACE is highest in the setting of an incompetent sphincter of Oddi, with a reported incidence of up to 86%. However, there is a lack of literature on these complications after bland embolization. The purpose of this study was to assess the incidence of biliary complications, cholecystitis, and abscess formation in HCC patients following bland embolization. Materials: Retrospective review of HCC patients treated with bland embolization over a 10-year period revealed 384 procedures in 212 patients. Embolization was performed with particles mixed with antibiotics in addition to IV antibiotics. All follow-up imaging after treatment were retrospectively reviewed for the development of bilomas, biliary dilation, biliary strictures, acute cholecystitis, and hepatic abscess. Clinic notes and laboratory tests were also reviewed. Results: Mean follow up duration was 18.2 months. In total, there was one biliary complication consisting of biloma formation. This patient had subsegmental hepatic infarction identified on imaging 8 days post embolization in the setting of subsegmental portal vein thrombus, with subsequent biloma development. There were no cases of new biliary dilation or strictures in the embolized portion of the liver at any point after treatment. One patient developed acute gangrenous cholecystitis 10 days post procedure. No patients developed a hepatic abscess, although 18 patients had an incompetent sphincter of Oddi. Conclusions: Biliary complications and cholecystitis occurred extremely rarely after bland embolization, at a markedly lower rate than historical data on TACE. Despite an incompetent sphincter in 18 patients, bland embolization with particles mixed with antibiotics resulted in zero abscesses, in contrast to a very high rate after TACE in the literature.
Abstract No. 288
Tumor grade and primary treatment response following DEB-TACE for hepatocellular carcinoma based on liver explant T. Sandow, A. Albar, P. Gulotta, G. Bennett, G. Galliano, D. DeVun, D. Kirsch, J. Gimenez, D. Malkerneker, P. Gilbert, H. Bohorquez, D. Kay; Ochsner Clinic Foundation, New Orleans, LA
Abstract No. 289
Biliary complications and abscess formation after bland embolization for the treatment of HCC Q. Wang1, J. Ronald2, M. Hall2, P. Suhocki2, C. Kim2; 1 Duke Univ / Huazhong University of Science and Technology, Durham, NC; 2Duke University Medical Center, Durham, NC
TUESDAY: Scientific Sessions
Purpose: Transarterial chemoembolization with drug-eluting beads (DEB-TACE) has demonstrated efficacy in downstaging or bridging HCC patients to transplant. The purpose of this study is to identify tumor characteristics based on primary treatment response with explant pathology for confirmation. Materials: A retrospective analysis was performed on all patients who were treated for HCC with DEB-TACE (100-300m LC Beads™ mixed with 50-75mg doxorubicin) and subsequently transplanted, which included 105 patients. Of these 105 patients, 93 had post-treatment imaging with triple phase CT or MRI prior to transplantation. Primary treatment response was based on modified RECIST criteria at the time of one month follow-up imaging. HCC was confirmed on explant in 84 patients, as 9 patients demonstrated complete tumor necrosis, prohibiting tumor grade classification. Tumor grade and lymphovascular invasion were included in the pathologic findings and compared to the primary treatment response. Results: Of the 84 patients, lower grade tumors were noted in 75 patients (G1, n ¼ 11; G2, n ¼ 64), and 9 were poorly differentiated (G3, n ¼ 6; G4, n ¼ 3). Low grade tumors showed favorable treatment response in 83% (CR,38%; PR,45%; SD,17%), as opposed to poorly differentiated tumors (CR,0%; PR,11%, SD,89%), po0.0001. Lymphovascular invasion was present in 15% of lower grade tumors as opposed to 67% of higher grade tumors (p ¼ 0.001). Similarly, patients with a favorable treatment response (CR or PR) on imaging were more likely to be G1/G2 as opposed to G3/G4 (98% vs 2%, po0.0001). Treatment response also correlated with the presence of lymphovascular invasion on
3:54 PM