P-112 - Local combination therapy with chemoembolization and microwave ablation in patients with Hepatocellular Carcinoma – a single center experience

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Hepatobiliary Cancers
Surgery and/or Radiotherapy of Cancer
Presenter H. Fernandes
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors H. Fernandes, J. Sinha, A. Sherwani, K. Lindsay, A. Befeler, S. Gadani, N. Poddar
  • St Louis/US

Abstract

Introduction

Chemoembolization (DEB-TACE) and microwave ablation (MWA) are established therapies for early and intermediate stage hepatocellular carcinoma (HCC). Conventionally, DEB-TACE is used as palliative therapy or as a bridge to transplant for intermediate stage HCC. MWA is used as curative therapy in early stage HCC. When used independently, both therapies have limitations. Embolization with DEB-TACE upregulates vascular endothelial growth factor (VEGF) leading to higher chances of recurrence at treated and distant sites. MWA when used alone cannot be used in large tumors because of heat dissipation and high chances of recurrence adjacent to blood vessels secondary to “heat sink” effect. When DEB-TACE is done before MWA, blood flow in and adjacent to the tumor is occluded, thereby reducing heat. This allows for larger and homogenous ablation zone, markedly reducing the heat sink effect. While success of synergistic effect of DEB-TACE and radiofrequency ablation (RFA) is well studied and reported, limited data exists regarding combination therapy using MWA.

Methods

A retrospective chart review was performed. Patients with imaging evidence of HCC were treated with DEB-TACE followed by MWA. Decision to offer combination therapy was based on multidisciplinary consensus. DEB-TACE was performed with particles loaded with doxorubicin and was followed by MWA the following day. Tumor markers, imaging features and liver function were evaluated before procedure and on first follow-up at 6 weeks. Imaging response evaluation was done using the Modified RECIST criteria (m RECIST).

Results

Our review revealed the following. A total of fourteen patients with Barcelona Clinic Liver Cancer Stage A & B were treated with combination therapy DEB-TACE and MWA. MELD scores ranged from 6 to 27 and Child Pugh scores ranged from A6 to B7. Results revealed a complete response in 50% (n = 7), partial response in 19% (n = 3), stable disease in 15% (n = 2) and progressive disease in 15% (n = 2). Response evaluation was based on m RECIST criteria. No immediate post procedural complications requiring hospitalisation were noted.

Conclusion

Our results demonstrate a “proof-of-concept” of safety and short term efficacy of combination therapy with DEB-TACE followed by MWA in local therapy for early and intermediate stage hepatocellular carcinoma. This is safe with excellent imaging response (a surrogate marker for survival) on short-term follow up. Further long-term results from our study are awaited.