Case Report

Transarterial chemoembolization (TACE) in hepatocellular carcinoma BCLC B patients: case series

Ni Nyoman Widyasari , Firman Parulian Sitanggang, Putu Patriawan, Dewa Gede Mahiswara

Ni Nyoman Widyasari
Radiology Residency Program, Faculty of Medicine, Universitas Udayana-Sanglah General Hospital Denpasar, Bali, Indonesia. Email: widyaimbawan99@gmail.com

Firman Parulian Sitanggang
Departement of Radiology, Faculty of Medicine, Universitas Udayana-Sanglah General Hospital Denpasar, Bali, Indonesia

Putu Patriawan
Departement of Radiology, Faculty of Medicine, Universitas Udayana-Sanglah General Hospital Denpasar, Bali, Indonesia

Dewa Gede Mahiswara
Departement of Radiology, Faculty of Medicine, Universitas Udayana-Sanglah General Hospital Denpasar, Bali, Indonesia
Online First: March 02, 2021 | Cite this Article
Widyasari, N., Sitanggang, F., Patriawan, P., Mahiswara, D. 2021. Transarterial chemoembolization (TACE) in hepatocellular carcinoma BCLC B patients: case series. Intisari Sains Medis 12(1): 14-18. DOI:10.15562/ism.v12i1.916


Introduction: Hepatocellular carcinoma (HCC) is the fifth leading cause of death for men and the seventh for women worldwide, HCC is one out of 10 most cancers in Indonesia. HCC grows in the background of chronic liver disease and often associated with hepatitis virus infection such as hepatitis B virus (HBV) and hepatitis C virus (HCV).  Transarterial chemoembolization (TACE) is a minimally invasive procedure performed by interventional radiologist as the treatment of choice for intermediate stage HCC.

Case report: Here in we report a 62 and 59 years old female with hepatocellular carcinoma Barcelona clinic liver cancer (BCLC) B who were treated with TACE using 50 mg doxorubicin mixed with Iopamiro and lipiodol. Both were patients with history of HBV infection. After 5 weeks of TACE, triphase abdominal CT-Scan was done to evaluate tumour progression, however one patient was loss to follow up.  Evaluation of one patient was done and revealed more than 30% decrease  solid viable tumour with increase of necrotic area.  Expansion of necrotic area is one of the HCC treatment response criteria, while decrease tumour enhancement explains the viability of the tumour itself.

Conclusion: TACE is the therapy of choice for patient with HCC BCLC B, which can give enlargement of necrotic area and decrease tumour viability.  

References

Zhu RX, Seto WK, Lai CL, et al. Epidemiology of hepatocellular carcinoma in the Asia-Pacific region. Gut Liver. 2016;10:332–339.

Zhang YJ, Chen Y, Ahsan H, et al. Silencing of glutathione S-transferase P1 by promoter hypermethylation and its relationship to environmental chemical carcinogens in hepatocellular carcinoma. Cancer Lett. 2005;221:135–143.

Wai IH, Ang Y, Heng N, An S. Hepatitis B E-antigen and the risk of hepatocellular carcinoma Background The presence of hepatitis B e antigen. N Engl J Med. 2002;347:168–174.

Chen CJ, Yang HI, Iloeje UH. Hepatitis B virus DNA levels and outcomes in chronic hepatitis B. Hepatology; 49. Epub ahead of print 2009. DOI: 10.1002/hep.22884.

Cartier V, Aubé C. Diagnosis of hepatocellular carcinoma. Diagn Interv Imaging. 2014;95:709–719.

Colombo M. Screening for cancer in viral hepatitis. Clin Liver Dis. 2001;5:109–122.

Duseja A. Staging of Hepatocellular Carcinoma. J Clin Exp Hepatol 2014;4:S74–S79.

Chanyaputhipong J, Low SCA, Chow PKH. Gadoxetate Acid-Enhanced MR Imaging for HCC: A Review for Clinicians. Int J Hepatol. 2011;2011:1–13.

Kinoshita A, Onoda H, Fushiya N. Staging systems for hepatocellular carcinoma: Current status and future perspectives. World J Hepatol. 2015;7:406–424.

Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018;391:1301–1314.

Sun HL, Ni JY, Jiang XY, et al. The effect of lipiodol deposition in HCC after TACE on the necrosis range of PMCT. Onco Targets Ther. 2017;10:3835–3842.

Liapi E, Geschwind JFH. Transcatheter Arterial chemoembolization for liver cancer: Is it time to distinguish conventional from drug-eluting chemoembolization? Cardiovasc Intervent Radiol 2011;34:37–49.

Miller RP, Tadagavadi RK, Ramesh G, et al. Mechanisms of cisplatin nephrotoxicity. Toxins (Basel). 2010;2:2490–2518.

Forner A, Ayuso C, Varela M, et al. Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma: Are response evaluation criteria in solid tumors reliable? Cancer. 2009;115:616–623.

Lencioni R, Petruzzi P, Crocetti L. Chemoembolization of Hepatocellular Carcinoma With Doxirubicin-Ethiodol. Invest Radiol. 1993;28:1185.

Piscaglia F, Ogasawara S. Patient Selection for Transarterial Chemoembolization in Hepatocellular Carcinoma: Importance of Benefit/Risk Assessment. Liver Cancer. 2018;7:104–119.

Vincenzi B, Di Maio M, Silletta M, et al. Prognostic relevance of objective response according to EASL criteria and mRECIST criteria in hepatocellular carcinoma patients treated with loco-regional therapies: A literature-based meta-analysis. PLoS One. 2015;10:1–12.

Lencioni R. New data supporting modified RECIST (mRECIST) for hepatocellular carcinoma. Clin Cancer Res. 2013;19:1312–1314.

Najmi VF, Pandey A, Aliyari Ghasabeh M, et al. Prediction of post-TACE necrosis of hepatocellular carcinoma usingvolumetric enhancement on MRI and volumetric oil deposition on CT, with pathological correlation. Eur Radiol. 2018;28:3032–3040.

Ye XD, Yuen Z, Zhang J, et al. Radiological biomarkers for assessing response to locoregional therapies in hepatocellular carcinoma: From morphological to functional imaging (Review). Oncol Rep. 2017;37:1337–1346.


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