Conventional versus drug-eluting beads chemoembolization for hepatocellular carcinoma: Emphasis on the impact of tumor size

Background and AimThis study aims to evaluate clinical outcomes of patients with hepatocellular carcinoma who underwent transarterial chemoembolization (TACE) using drug-eluting beads (DEB). Patients and MethodsThis study retrospectively compared the clinical outcomes of 250 consecutive patients who underwent DEB-TACE (n=106) or conventional TACE (cTACE) (n=144) in a tertiary center between January 2010 and April 2014. The median age of the patients was 62years and 81.6% were men. The primary endpoint was overall survival (OS). The time to progression (TTP), radiological response rate using modified response evaluation criteria in solid tumors criteria at 1month after treatment, and complication rates within 1month were also compared. ResultsThe most common etiology was hepatitis B virus infection. The median index tumor size was 2.8cm, and 150 (60.0%) patients had Barcelona Clinic Liver Cancer stage B. Median TTP in the cTACE group was longer than in the DEB-TACE group (13.3 vs10.8months; P=0.023). However, DEB-TACE and cTACE groups showed no significant differences for mean OS (46.6 vs 44.9months; P=0.660) and disease control rate at 1month (78.3% vs 86.8%; P=0.076). The OS, TTP, and disease control rate were also not different between two groups, even when subgrouped by index tumor size. The complication rates within 1month were higher in the cTACE group (6.6% vs 14.6%; P=0.048). ConclusionsDrug-eluting beads TACE appears to be a safe intra-arterial therapy. However, it is not superior to cTACE in terms of efficacy. Tumor size might not be a criterion to select treatment modality between cTACE and DEB-TACE in terms of efficacy.