Transarterial chemoembolization with gelatin sponge microparticles for Barcelona clinic liver cancer Stage C and large hepatocellular carcinoma: Initial clinical experience

Objective: The purpose of this investigation is to present a preliminary clinical experience in transarterial chemoembolization (TACE) with gelatin sponge microparticles (GSMs) for Barcelona clinic liver cancer (BCLC) Stage C and large hepatocellular carcinoma (HCC) patients in China. Materials and Methods: Between August 2009 and August 2012, 20 BCLC Stage C HCC patients with tumor size ≥5 cm undergoing GSMs-TACE were retrospectively analyzed. Tumor response was evaluated using modified response evaluation criteria in solid tumors (mRECIST) with enhanced magnetic resonance/computed tomography imaging performed 4-6 weeks after each GSMs-TACE procedure. Kaplan-Meier curves were used to assess overall survival (OS). Complications postprocedure was also analyzed. Results: In this cohort of 20 HCC patients, vascular invasion was present in 8 patients (40%), extrahepatic metastases in 6 patients (30%), and both in 6 individuals (30%). Median tumor size was 9.9 ± 3.2 cm. All procedures were successfully performed with minimal complications. The mean number of TACE per patient was 2.6 sessions (range 1-5). Median OS (mOS) was 14 months for the entire study population. Survival rates at 6 and 12 months were 85% and 73.7%, respectively. According to mRECIST criteria, follow-up images were obtained 6 months after initial GSMs-TACE. Five patients (25.0%) achieved complete response, 8 patients (40.0%) had partial response, 4 (20.0%) had stable disease, and 3 (15.0%) had progressive disease. The objective response rate for TACE was 65%. Conclusions: From our preliminary clinical experience, GSMs-TACE in the treatment of BCLC Stage C and large HCC appears to offer favorable survival and tumor response with low morbidity. However, further prospective studies are required to assess its safety and efficacy.