EVALUATION OF TRANSARTERIAL EMBOLIZATION ABLATION OF HEPATOCELLULAR CARCINOMA WITH ABSOLUTE ALCOHOL

Abstract

Hepatocellular carcinoma (HCC) is one of the most common types of cancer in Vietnam and some regions of the world such as Asia and Africa.1,2 According to GLOBOCAN 2018, HCC ranked 6th for incidence, and ranked 4rd for mortality among the 36 most common cancers.3 There were nearly 850.000 new cases, more than 780.000 deaths in 2018 worldwide.3 There are many methods of HCC treatment, and the appropriate method depends on several factors such as liver function, diagnostic imaging, performance status of patients. Treatment could be divided into groups including (1) curative treatment such as liver resection, liver transplantation, radio frequency ablation (RFA), percutaneous ethanol injection therapy (PEIT) for very early stages; (2) transarterial chemo-embolization (TACE) for intermediate stage (3) systemic therapy such us sorafenib for progressive stage; (4) symptomatic treatment in the late stage.4,5 For the early stage, liver resection is selected. Only 10-30% of patients are candidate for surgery, because the majority are detected in the late stage.6 Liver transplantation is a good treatment, but the source of liver using for transplantation is rare and expensive, and patients face the risk of rejection after transplantation. In addition, RFA is a curative treatment with a complete response rate up to 80-100% for tumors ≤3cm, 50-80% for tumors 3-5cm, 25% for tumors> 5cm.6 The greater tumors are, the less effectiveness of RFA is, and there is usually no indication for tumors >7cm.7 For the intermediate stage in patients with preserved liver function, large and multiple tumors, the treatment of transarterial embolization is established.5 The transarterial embolization has been used since the 1980s, including the conventional TACE, and TACE with other materials (such as Dc Bead or TANDEM microspheres), transarteial ablation ethanol (TAE). In particular, TACE has been widely used.8 Normal hepatic parenchyma are nourished by the portal vein (80%) and the hepatic artery (20%). However, the main blood supply to HCC tumors is from the arterial sources.8 Research has shed light on that large HCC tumors ( >5cm) are supplied with blood from the hepatic artery and the portal vein, so TACE required several times to achieve complete response.8 TAE is one of the options of the transarterial embolization. There was one clinical case report with a large HCC tumor repeatedly treated with TACE, the patient gained incomplete response. After TAE procedure, it showed good results with complete response up to 36 months.9 Not only that, other studies have pointed out that TAE demonstrated better complete tumor response, longer time to intralesional progression, and longer progression-free survival, low treatment-related adverse events rates and low cost.8,10,11 In a recent study, it was shown that overall survival with TAE was higher than TACE for large tumors ≥7cm.10 Notably, most HCC patients in our country hospitalize at late stage with big size of tumors,12 so group of this population should be focused on. There has been no research to evaluate the effectiveness of TAE for HCC treatment in Vietnam so far, so we conduct the research “Evaluation of transarterial embolization ablation for hepatocellular carcinoma with absolute alcohol" with 2 main purposes below 1. Describing the image characteristics on computed tomography (CT) and digital subtraction angiography (DSA) of HCC treated with TAE 2. Evaluating effectiveness and safety of HCC treatment with TAE