Imaging Changes and Clinical Complications After Drug-Eluting Beads Versus Conventional Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma: Multicenter Study.

Background: Drug-eluting beads transarterial chemoembolization (DEB-TACE) has emerged as an alternative to conventional transarterial chemoembolization (cTACE) for treatment of hepatocellular carcinoma (HCC), although selection between the approaches remains controversial. Objective: To compare patients with unresectable HCC treated with DEB-TACE and cTACE in terms of hepatobiliary changes on imaging and clinical complications. Methods: This retrospective study included 1002 patients (871 men, 131 women; mean age, 59±12 years) from three centers with treatment-naive unresectable HCC who underwent 780 DEB-TACE using epirucibin (780 procedures in 394 patients) and 1187 cTACE using lipiodol mixed with doxorubicin and oxaliplatin (1187 procedures in 608 patients) between May 2016 and November 2018. A total of 83.4% of patients had hepatitis B related liver disease; 57.6% were Barcelona Clinic Liver Cancer (BCLC) stage A or B; 42.4% had ≥3 nodules. Mean tumor size was 6.3±4.2 cm. Hepatobiliary changes and tumor response were evaluated on CT or MRI 1 month after TACE. Clinical records were reviewed for adverse events. Results: Bile duct dilation and portal vein narrowing on imaging, as well as liver failure and grade 3 abdominal pain on clinical follow-up, all had higher frequency (p .05). Local tumor disease control rate (DCR) was not different between cTACE and DEBTACE (p>.05), although overall DCR was higher in cTACE than DEB-TACE (1 month: 87.5% vs 80.0%, p=.001; 3 months: 78.5% vs 72.1%, p=.02). Conclusion: Compared with cTACE, DEB-TACE was associated with more frequent hepatobiliary injuries and severe abdominal pain. Clinical impact: Greater caution and closer follow-up are warranted for patients who undergo DEB-TACE for unresectable HCC.