Conventional vs. DEB vs. DSM: Which technique for palliative TACE in intermediate-stage HCC? Results on 70 patients in terms of efficacy and tolerance.

purposeThis study aims to compare palliative cTACE, DEB-TACE and DSM-TACE in patients affected by HCC in intermediate BCLC stage in terms of efficacy and patient tolerance. MATERIALS AND

methodsPatients treated with palliative TACE were prospectively enrolled in two centers during 9 months. Procedures were performed superselectively in all patients. Inclusion criteria were: HCC diagnosis, intermediate BCLC stage, portal tree patency, preserved hepatic-renal-coagulation functions, palliative procedural aim, follow-up available up to 6-month post-TACE intervention. Exclusion criteria were: previous TACE treatments, alone or in combination with ablation in the same session, ascites, bilirubin > 2mg/dL, age < 18years, bridge to transplant procedural aim, concomitant infectious diseases. Primary endpoint was to compare efficacy and patients tolerance among the 3 different TACE techniques; secondary endpoint was to compare post-procedural complications occurrence.

resultsSeventy patients were included and divided into three groups according to the TACE technique: 24 were treated with cTACE, 25 with DEB-TACE, 21 with DSM-TACE. According to mRECIST criteria at 1-, 3- and 6-month follow-up, DEB-TACE presented better local response rates but without statistically significant differences. Patients treated with DSM-TACE showed significantly better tolerance, considering post-procedural transaminases and INR values together with clinical adverse events occurrence monitored up to 7 days. There were no differences in post-procedural complications and no major complications occurred.

conclusionsIn this study, in patients with intermediate-stage HCC undergoing palliative treatments, no significant differences emerged comparing cTACE, DEB-TACE and DSM-TACE in terms of procedural efficacy; however, patients treated with DSM-TACE showed significant better procedural tolerance.