Intra arterial treatment of hepatocellular carcinoma: Comparison of MELD score variations between radio-embolization and chemo-embolization - 05/07/19

Doi : 10.1016/j.diii.2019.05.006

J. Delicque ^a,^⁎ , M. Hermida ^a, L. Piron ^a, C. Allimant ^a, A. Belgour ^a, G.-P. Pageaux ^b, F. Ben Bouallegue ^c, E. Assenat ^d, D. Mariano-Goulart ^d, B. Guiu ^a, C. Cassinotto ^a
^a Department of Diagnostic and Interventional Radiology, University Hospital of Montpellier, Hôpital Saint-Eloi, 34070 Montpellier, France
^b Department of Hepatogastroenterology, University Hospital of Montpellier, Hôpital Saint-Eloi, 34070 Montpellier, France
^c Department of Nuclear Medicine, University Hospital of Montpellier, Hôpital Lapeyronie, 34070 Montpellier, France
^d Department of Digestive Oncology, University Hospital of Montpellier, Hôpital Saint-Eloi, 34070 Montpellier, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 05 July 2019
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Purpose

The purpose of this study was to assess liver function deterioration, as assessed using the model for end-stage liver disease (MELD) score variations, following transarterial chemo-embolization (TACE) versus selective internal radiation therapy (SIRT) in patients with unresectable unilobar hepatocellular carcinomas (HCC).

Patients and methods

We retrospectively evaluated all patients who underwent a single conventional TACE or SIRT procedure in our department from May 2013 to May 2018 for unilobar unresectable HCC. A total of 86 patients (76 men, 20 women; mean age, 65.5 years) were included. There were 63 patients in the TACE group [56 men, 7 women; mean age, 65.1±9.6 (SD) years] and 23 patients in the SIRT group [20 men, 3 women; mean age, 70±9.2 (SD) years]. Delta MELD, defined as post treatment minus pre-treatment MELD score, was considered for liver function deterioration and compared between patients who underwent single lobar treatment of SIRT versus TACE.

Results

Patients in SIRT group had significant higher tumor burden, alpha-fetoprotein serum level, and rates of macroscopic vessel invasion. Mean pre-treatment MELD scores did not differ between TACE [mean, 8.41±1.71 (SD); range: 7.24–9.24] and SIRT groups [mean, 8.36±1.74 (SD); range: 7.07–9.21] (P=0.896) as well as Child-Pugh class and albumin-bilirubin (ALBI) grade distribution. However, following treatment, mean DeltaMELD was greater in TACE group (mean, 0.83±1.83 [SD]; range: −0.30–−1.31) than in SIRT group (mean, −0.13±1.06 [SD]; range: −0.49–0.32) (P=0.021). At multivariate analysis, SIRT treatment was independently associated with a lower DeltaMELD score than TACE (R=−0.955 [−1.68; −0.406]; P=0.017;).

Conclusion

Whereas performed in patients with higher tumor burden, SIRT resulted in lower degrees of liver function worsening as assessed using MELD score variations.

Le texte complet de cet article est disponible en PDF.

Keywords : Hepatocellular carcinoma, Chemo-embolization, Therapeutic, Radiation Radio embolization, Toxicity