Saturday, 5 September 2015

ILCA Symposium 3: Advances in Transarterial Treatment of HCC

Advances in Transarterial Tumour Therapy: Does Novel Technology Mean Better Outcomes?

Thierry de Baere, MD (France)

Conventional TACE (c-TACE) using Lipiodol with doxorubicin or cisplatinum is established as a standard of care in intermediate stage HCC, due to positive results of randomized controlled trials published in 2002. Since this publication, no treatment has been demonstrated superior.
However, many advances have been carried out by the medical community including: new compound to deliver intra-arterially, new technologies in image guidance, and refinement in patient selection.
New compounds are new platforms to deliver doxorubicin in drug eluting beads (DEB), which today has failed to demonstrate superiority to c-TACE in 2 randomized studies with tumour response and OS as primary end points. Improvement in DEB technology is ongoing with loading of new agents such as sunitinib, or the development of resorbable beads that are expected to lower some of the side effects of DEB-TACE.
Internal radiation therapy with Lipiodol I131 injected through the hepatic artery has demonstrated in the 90s to improve survival in HCC patients with portal vein thrombosis. Y90 loaded microsphere is an advancement in such a treatment that allows to target HCC patients with PVT and several randomized studies will soon be completed to validate this treatment approach.
Image guidance and catheter navigation has evolved with the use of microcatheter and improvement in angiographic imaging, namely with cone beam CT-3D angiography (CBCT). Such CBCT angiography has been demonstrated to give additional information in ¾ of the procedures, and modify treatment in roughly 1/4 of the cases. Moreover, such imaging technologies allows for early detection of untreated targets and has been demonstrated on retrospective study to significantly technical success versus DSA and decrease local recurrence rates between grade A and B tumours (p \ 0.001). The 1-, 2-, and 3-year local recurrence rates in the DSA and CBCT groups from 48% to 30.6%, after 3 years.