Published online Dec 15, 2022. doi: 10.4251/wjgo.v14.i12.2367
Peer-review started: August 1, 2022
First decision: August 21, 2022
Revised: August 29, 2022
Accepted: November 16, 2022
Article in press: November 16, 2022
Published online: December 15, 2022
Liver cancer is a malignant tumor with high morbidity and mortality. Transcatheter arterial chemoembolization (TACE) is the main method for surgically unresectable liver cancer. In recent years, drug-loaded microspheres have been gradually applied in TACE technology. There are some controversies about the therapeutic effects of drug-loaded microspheres TACE (D-TACE) and traditional TACE.
To explore the short-term efficacy of D-TACE and traditional TACE in the treatment of advanced liver cancer.
The clinical data of 73 patients with advanced liver cancer admitted to the First and Sixth Medical Centers of Chinese PLA General Hospital from January 2017 to October 2019 were retrospectively analyzed. Among them, 15 patients were treated with D-TACE, and 58 patients were treated with traditional TACE. Clinical baseline characteristics, perioperative laboratory indices, postoperative adverse reactions and postoperative complications were compared between the two groups.
There was no statistical difference between the two groups for the postoperative response: The highest postoperative body temperature of the drug-loaded microsphere group was 38.0 ± 0.9℃ and the postoperative highest body temperature of the traditional TACE group was 38.3 ± 0.7℃ (t = -1.414, P = 0.162). For the 24 h postoperative nausea and vomiting after surgery in terms of scoring and postoperative pain scores, the traditional TACE group was higher than the drug-loaded microsphere group (χ2 = 14.33, P = 0.014; χ2 = 32.967, P = 0.000) and the two groups had significant statistical differences. The disease control rate at 3 mo after treatment in the drug-loaded microsphere group was 60% and the disease control rate at 3 mo after treatment in the traditional TACE group was 75.9% (χ2 = 4.091, P = 0.252). There was no statistical difference between the two groups of data. During the follow-up period, the number of interventional treatments received was once in the drug-loaded microsphere group and the traditional TACE group received an average of 1.48 treatments (χ2 = 10.444 P = 0.005). There was a statistical difference between the two groups.
Compared with traditional TACE, D-TACE may have some advantages in the treatment of advanced hepatocellular carcinoma with a large tumor load in the short term, but the long-term clinical efficacy needs additional follow-up studies. In addition, compared with the traditional group, the patients in the drug-loaded microsphere group had better subjective tolerance and could reduce the number of interventional treatments. Therefore, D-TACE is worthy of clinical promotion.
Core Tip: Hepatocellular carcinoma with a very high mortality rate is insidious and about 80 per cent of patients have no chance of surgery when diagnosed. Transcatheter arterial chemoembolization (TACE) is recommended as a first-line treatment. Traditional TACE uses iodized oil and gelatin sponge as the main embolization materials, and the chemotherapeutic drugs are mixed with iodized oil and injected into the tumor feeding artery to achieve the dual role of embolization and chemotherapy. Some scholars believe that liver cancer cells are not sensitive to chemotherapy drugs, so the role of chemotherapy drugs in TACE treatment is controversial. In recent years, drug-loaded microspheres have been gradually applied in TACE technology, which can significantly improve the killing effect of drugs on tumor tissues, and significantly reduce the systemic drug concentration, thereby reducing the side effects of chemotherapy drugs. In this study, the effects of using the same size of embolization particles and drug-eluting beads during TACE were compared. To investigate the effect and systemic response of chemotherapy drugs in TACE under the new local drug delivery mode.