Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Mainz, Germany.
Abdom Radiol (NY). 2020 Oct;45(10):3326-3336. doi: 10.1007/s00261-019-02349-w.
To compare two different types of drug-eluting microspheres with regard to impact on HRQoL after first TACE, tumour response, peri-procedural complications, adverse events and 1-year survival in patients suffering from unresectable hepatocellular carcinoma (HCC).
HRQoL was prospectively assessed with validated questionnaires (EORTC QLQ-C30 and -HCC18) before and 2 weeks after treatment with their first drug-eluting beads (DEB-)TACE with either acrylamido-polyvinylalcohol-AMPS hydrogel microspheres (group; 20 patients) or polyvinyl alcohol-co-acrylic acid microspheres (group; 16 patients). Baseline characteristics, peri-procedural complications, treatment-related adverse events and 1-year survival were compared between both types of microspheres. Treatment response and objective response rates (ORR) were analysed using established tumour response criteria. Subgroup analysis for pooled groups with small (group; 21 patients) versus large particles (group; 15 patients) was performed.
At baseline, there were no significant differences between the treated microsphere groups. No significant differences were found in absolute HRQoL changes after first DEB-TACE between the different types of microspheres. Response rates and survival were comparable between the investigated microsphere groups. For group, we found a significant difference in post-interventional deterioration of physical function (- 19.4%) compared to group (- 8%; p = 0.025). Tumour response and ORR according to mRECIST were significantly higher in group (p = 0.008; p = 0.009).
DEB-TACE is generally well tolerated and effective, with comparable changes in HRQoL for both types of drug-eluting microspheres. Tumour response is better with small microspheres. A relevant deterioration of physical function underlines that an aggressive TACE using small beads should be well deliberated.
比较两种不同类型的载药微球在首次 TACE 后对不可切除肝细胞癌（HCC）患者的生活质量（HRQoL）、肿瘤反应、围手术期并发症、不良事件和 1 年生存率的影响。
使用经过验证的问卷（EORTC QLQ-C30 和 -HCC18）对首次载药微球 TACE（DEB-TACE）治疗前和治疗后 2 周的 HRQoL 进行前瞻性评估，微球分别为丙烯酰胺-聚乙烯醇-AMPS 水凝胶微球（组，20 例）或聚乙烯醇-丙烯酸共聚物微球（组，16 例）。比较两种微球的基线特征、围手术期并发症、治疗相关不良事件和 1 年生存率。采用既定的肿瘤反应标准分析治疗反应和客观缓解率（ORR）。对小颗粒（组，21 例）和大颗粒（组，15 例）两组进行合并亚组分析。
在基线时，两组治疗的微球之间没有显著差异。两种不同类型的微球首次 DEB-TACE 后 HRQoL 的绝对变化无显著差异。两种微球组的反应率和生存率相当。在组中，与组（-8%，p=0.025）相比，介入后身体功能的恶化有显著差异（-19.4%）。根据 mRECIST，组的肿瘤反应和 ORR 明显更高（p=0.008；p=0.009）。
DEB-TACE 通常耐受性良好且有效，两种类型的载药微球对 HRQoL 的影响相似。小粒径微球的肿瘤反应更好。身体功能的显著恶化表明，使用小粒径微球进行积极的 TACE 应慎重考虑。
