Purpose: The aim of this study was to determine whether or not the number of arteries treated during transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) significantly affects treatment outcomes. While selectivity of TACE has been shown to affect radiologic outcomes, no evaluation of the number of feeding arteries which are treated, when normalizing for treatment selectivity has been performed. This is of interest as the complexity of arterial supply may affect the ability to treat the entirety of the lesion effectively and thus influence treatment outcomes.
Material and Methods: Internal review board approval was gained for a retrospective single center study of 198 patients who underwent treatment for 317 HCCs between 1/1/2011 and 12/31/2016. Tumor location, radiologic response to treatment, complications and time to progression (TTP) were recorded. Radiologic response (RR) was determined based on European Association for the Study of the Liver (EASL) classification system and performed at two time points, after initial therapy and “maximal” response which recorded the best EASL response after multiple therapies when applicable. TTP was measured from first TACE and censored for transplantation.
Results: Single artery treatment was performed in 244 patients (77%) and 73 (23%) had >1 artery treated. The two groups did not differ significantly in selectively of TACE treatment with the majority being treated at the segmental or sub segmental levels (1 artery 186/244 76.2% vs >1 artery 58/73 79.4%, p=0.26). The RR did not differ between the two groups either after initial treatment (1 artery complete response (CR) 138/244 56.6%, partial response (PR) 59/244 24.2%, stable disease (SD) 42/244 17.2%, progressive disease (PD) 5/244, 2% vs >1 artery CR 36/73 49.3%, PR 19/73 26%, SD 15/73 20.5%, PD 3/73 4.1%, p=0.52) or after maximal RR (1 artery CR 163/244 66.8%, PR 54/244 22.1%, SD 22/244 9%, PD 5/244 2% vs >1 artery CR 45/73 61.6%, PR 16/73 21.9%, SD 9/73 12.3%, and PD 3/73 4.1%, p=0.56). TTP also did not vary by number of arteries treated (p=0.38).
Conclusions: There is no significant difference in the RR or TTP in patients who are treated for HCC with TACE of 1 or more than 1 artery when controlling for selectivity.