TACE with drug-eluting beads is effective for the maintenance of the milan-in status in patients with a small hepatocellular carcinoma

BACKGROUND AND AIM:Transarterial chemoembolization (TACE) is the standard of care for treatment of patients with an intermediate (BCLC B) hepatocellular carcinoma (HCC) and to bridge patients with an early cancer to liver transplantation (LT). We explored the efficacy of TACE with drug eluting beads (DEB) in BCLC A patients.METHODS:Included are all BCLC A patients unsuitable to resection or locoregional ablation who between 2006-2012 consecutively underwent a DEB TACE. Treatment was carried out "a la demande" until complete tumor devascularization or progression beyond Milan criteria. In patients with a complete response (CR), a contrast computerized tomography (CT) scan was repeated at three month intervals during the first 2 years and then every 6 months alternating with abdominal ultrasound (US) in the subsequent 3 years.RESULTS:Fifty-five patients had 79 tumor nodules ranging 7-50 mm, 32 (58%) achieved a CR that was maintained up to 4 and 7 months in 21 (38%) and 17 (31%) patients, respectively. The 24- and 36-month tumor-free-survivals were 21% and 9%, respectively. The overall cumulative progression beyond Milan criteria at 3-, 6-, 12- and 24-months were 2%, 5%, 30% and 54%. LT eligibility was maintained for a median of 19 (range 2-63) months. CR to first TACE was the strongest independent predictor of Milan-in maintenance.CONCLUSION:DEB TACE may effectively bridge patients with an early cancer to LT and a CR to the first procedure may guide patient prioritization during the waiting list.