1 / 20

4 YEARS SURVIVAL OF 100 HCC PATIENTS TREATED WITH DC BEAD: A RETROSPECTIVE ANALYSIS

4 YEARS SURVIVAL OF 100 HCC PATIENTS TREATED WITH DC BEAD: A RETROSPECTIVE ANALYSIS . Marta Burrel Vascular Interventional Unit Barcelona Clinic Liver Cancer Group Hospital Clínic. Barcelona, Spain. Normal. BCLC Classification and Treatment Schedule. HCC. Stage D. Stage 0.

meara
Download Presentation

4 YEARS SURVIVAL OF 100 HCC PATIENTS TREATED WITH DC BEAD: A RETROSPECTIVE ANALYSIS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 4 YEARS SURVIVAL OF 100 HCC PATIENTS TREATED WITH DC BEAD: A RETROSPECTIVE ANALYSIS Marta Burrel Vascular Interventional Unit Barcelona Clinic Liver Cancer Group Hospital Clínic. Barcelona, Spain.

  2. Normal BCLC Classification and Treatment Schedule HCC Stage D Stage 0 Stage A-C PST 0, Child-Pugh A Okuda 1-2, PST 0-2, Child-Pugh A-B Okuda 3, PST >2, Child-Pugh C Very early stage (0) Single< 2cm. Carcinoma in situ Early stage ( A) Single or 3 nodules < 3cm, PS 0 Terminal stage (D) Advanced stage (C) Portal invasion, N1,M1, PS 1-2 Intermediate stage ( B) Multinodular, PS 0 Single 3 nodules <3cm Portal pressure/ bilirubin Associated diseases Increased No Yes Liver Transplantation (CLT / LDLT) PEI/RF TACE Sorafenib Resection RCT: 40% - 50% at 3 yr vs 10% at 3yr Symptomatic treatment Curative Treatments: 50% - 75% at 5 years Forner et al. Semin Liver Dis. 2010 Feb;30(1):61-744

  3. Lipiodol TACE improves survival in a selected group of HCC patients Survival probability TACE Control 1 year 57% 32% 2 years 31% 11% Survival probability TACE Control 1 year 82% 63% 2 years 63% 27% 35% objective response > 6 months Independent prognostic factor Lo et al. Hepatology 200235(5):1164-71 Llovet et al. Lancet 200218;359(9319):1734-9

  4. Systematic Review of RCT for Unresectable HCC • Random effects model (DerSimonian & Laird) OR (95% CI) 0.5 0.01 0.1 10 100 1 2 Author,Journal, year Cumulative (pts) Lin, Gastroenterology 1988 63 GETCH, NEJM 1995 159 Bruix , Hepatology 1998 239 Pelletier, J Hepatol 1998 312 Lo, Hepatology 2002 391 Llovet, Lancet 2002 503 2p=0.086 OVERALL 503 2p=0.017 Heterogeneity: Q:7.73P=0.14 Median survival : ~ 20 months Favors treatment Favors control Llovet and Bruix. Hepatology 2002

  5. Cohort studies with TACE-DC Beads . Improved Objective Response . Better tolerance

  6. Randomization N=87 Chemoembolization vs Bland Embolization Compensate cirrhosis Child-Pugh A –B ECOG o-1 Number of nodules No difference in both groups Bland Embolization (n=41) TACE with DCB (n=43) • TACE-DEB better than Bland Embolization • Local response. Overall Response (p=0.04) • Fewer recurrence. At 9 months (p=0.002) • Longer TTP (p=0.008) Malagari et al.Cardiovasc Intervent Radiol. 2010 Jun;33(3):541-51. Epub 2009 Nov 24.

  7. TACE - DC Beads: Randomised Studies Precision V End Point: Negative Doxorubicin-Related Side Effects: Lammer et al. Cardiovasc Intervent Radiol (2010), 33(1):41-52

  8. SURVIVAL DATA AFTER TACE IN PATIENTS WITH HEPATOCELLULAR CARCINOMA (HCC) IN 2010: IMPACT ON CLINICAL PRACTICE AND RESEARCH

  9. OBJECTIVES • Evaluate the survival of HCC patients treated with TACE-DEB following a strict selection (preserved liver function, absence of cancer related symptoms, extrahepatic spread or vascular invasion) • Evaluate causes of untreatable progression (UTP)

  10. PATIENTS AND METHOD • HCC patients treated by TACE-DEB between February 2004 and March 2010 • Retrospective review of: • baseline characteristics • development of treatment related adverse events • overall survival

  11. RESULTS • - 97 patients evaluated • - Median follow up 24.4 months (2.6-79.6) • At the time of evaluation • 31 patients had died • 2 received transplantation • 22 had received Sorafenib because of progression not amenable for TACE

  12. Results: Characteristics of patients

  13. Función de supervivencia 1,0 Censurado 0,8 0,6 0,4 0,2 0,0 0,00 20,00 40,00 60,00 80,00 Survival (months) Results: Survival Median whole cohort survival : 47.7 months (95%CI: 36.6-58.8)

  14. Results: Survival OS 54.2 months for stage A OS 40.2 months for stage B Survival after censoring follow-up at the time of transplant or Sorafenib 40.2 months for BCLC A 31.9 months for BCLC B

  15. Results: Complications n=10

  16. Evolutionary events after TACE The untreatable progression concept TACE Objective response No objective response Retreatment strategy 2nd-line option Progression Treatable (i.e. additional small HCC) Untreatable (i.e. vascular invasion, M1) or Liver failure/contraindication TACE HCC progression controlled Prof Bruix.Personal communication

  17. Causes of untreatable progression leading to Sorafenib administration n= 22

  18. Precision V: Potential patients with UTP J Lammer et al. Cardiovasc Intervent Radiol. 2010 Feb;33(1):41-52.

  19. CONCLUSIONS • Current survival of non-ressectable HCC patients within stages A and B is 47,7 months • Current survival of BCLC B patients is 40,2 months • These new data update the previous survival results obtained from Lipiodol-TACE, which impacts in clinical practice and research purposes

More Related