Abstract YO15
Case summary
Our study is based on the experience of observing 38 patients (pts) with hepatocellular cancer (HCC) on the background of liver cirrhosis (LC), who underwent Transarterial Chemoembolization (TACE) at the “Ixlos” clinic from 2021 to 2023. A total of 50 TACE procedures were performed on 38 patients. 32 pts with the right lobe damage and 5 with the left lobe. Bilobar lesion was noted in 1 pt. 20 had concomitant HBV, 5 HCV, the remaining 13 had both HBV and HCV. There were no signs of invasion into the portal vein system. To clarify the diagnosis, a liver biopsy was performed. All pts were considered unresectable. According to the Child-Pugh classification of LC, pts corresponded to stages “B” (n=34; 89.5%) and “C” (n=4; 10.5%). Distribution of pts according to the Barcelona classification (BCLC): A4 stage - 3 (7.8%); B - 31 (81.5%); C - 4 (10.5%). TACE was performed from 1 to 4 times. Doxorubicin (50-100 mg) was used as a chemotherapeutic agent and Lipiodol (Guerbet, France) as a vehicle for it. In all cases, a chemo-oil suspension saturated with doxorubicin was injected directly into the tumor vessels. Assessment of the effectiveness of treatment and the dynamics of the process, as well as the decision to perform a repeat TACE procedure, were controlled by analyzing the level of aFP, CT and MRI with contrast 3-4 weeks after the procedure. Repeated TACE was performed after 1-4 months . All pts were prescribed lenvatinib 12 mg for 6 months parallel to TACE.
Results: Post-embolization syndrome: pain in the epigastrium, nausea, fever was observed in 6 (15.7%) patients and was relieved by symptomatic therapy for 3-8 days. Complications included: arterial hypotension during the procedure in one (2.6%), liver abscess in one (2.6%), obstructive jaundice in one (2.6%) patient. The last two complications were resolved surgically. Death from worsening liver failure occurred in two (5.2%) patients with BCLC-B. According to m-Recist criteria, a complete response was observed in 15 (39.5%) pts, of which 13 pts subsequently underwent liver resection. Partial response was observed in 13 patients (34.2%), stabilization in 9 (23.6%) and progression in 1 (2.6%). Currently, 36 (94.7%) pts are alive for a period of 3 to 31 months.