Background: Hepatocellular carcinoma is amongst the common causes of cancer deaths and has few curative treatment options. Transarterial chemoembolisation (TACE) is an option widely reported and used for palliative care and as a bridge to liver transplantation. Limited South African studies have examined the outcome of this type of therapy, with one comparing survival benefit and hospital stays in TACE using Adriamycin with lipiodol, with no benefit demonstrated. The current study aims to compare the imaging and alpha fetoprotein (AFP) responses with previous international studies on treatment response. Objectives:. To elucidate imaging and AFP outcomes after TACE in patients with hepatocellular carcinoma by measuring these in comparison with previous studies. Methods: 24 patients with hepatocellular carcinoma treated with TACE in the radiology department at Groote Schuur Hospital over a 4-year period were retrospectively reviewed by using an structured protocol. Baseline and post-TACE radiological features were assessed including tumour size and necrosis in conjunction with AFP levels were evaluated to determine tumour response. Results: During the study period 24 patients (17 males [70.8%] and 7 females[29.2%], with a mean age of 52.9 years) underwent TACE for HCC. 15 patients (62.5%) had documented cirrhosis, 14 patients (54 % ) had concomitant hepatitis, with hepatitis B being the commonest in 11 patients (45.8%). The majority of patients were Child Purgh A 21 patients (87.5% ) while 3 (12.5%) were Child Pugh B, 20 patients (83.3%) were TACE naïve, while 4 patient's (16.7%) had prior TACE treatment. 4 patient's (16.7%) of the study population had histologically confirmed hepatocellular carcinoma, 5 patients (20%) had HCC metastasis at baseline, 11 patients (45.8%) had AFP levels below 200ug/L and 13 patient's (54.2%) had levels above 200ug/L at baseline. 13 patients had large > 100 mm tumours at baseline, with median tumour size of 115 mm ( range 55,50-173 mm). 20 patients (83.3%) had imaging by 6 months (mean of 84 days, range 34- 126 days) post-TACE with a median tumour size of 91.00 mm [range 36.50-168.50 mm]. By both mRECIST criteria and EASL criteria, 10% of the study population had complete responses, 10% demonstrated partial responses by mRECIST criteria alone and none by EASL criteria. 20% had progressive disease by both mRECIST and EASL criteria. Stable disease was evident in 60% by mRECIST and 70% by EASL criteria.15 patients (62.5%) of the study population had AFP results post treatment, with a median of 624.00 micrograms/L (range 5.00 – 11548.00 micrograms/L). No patients demonstrated more than 90% reduction or normalisation of alpha-fetoprotein levels. 7 patients (46,67%) had greater than 50% but less than 90% reductions while 8 patients (53.3 %) had increased levels. The study demonstrated a weak correlation between alpha fetoprotein reduction and radiological response post-TACE (r = 0.085). Conclusion: Our study revealed 60% stable disease following TACE similar to 77% in the previous study by Lewandowski RJ et al ,with our 10% partial response compared to the 35% obtained by Llovet JM et al. The AFP had a 46% response compared to the one shown by Sherman et al which had 65%. TACE in patients with hepatocellular carcinoma has a modest radiological and biochemical response, with the majority of patients having stable disease.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/37822 |
| Date | 26 April 2023 |
| Creators | Sihlahla, Irvine |
| Contributors | Said-Hartley, Mariam |
| Publisher | Faculty of Health Sciences, Division of Radiology |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MMed |
| Format | application/pdf |
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