Treatment Outcomes of Ultraselective Transarterial Chemoembolization for Hepatocellular Carcinoma at Bach Mai Hospital

Abstract

Objective: To evaluate the therapeutic efficacy, safety, and local recurrence of ultraselective conventional transarterial chemoembolization (ultraselective cTACE) in the treatment of hepatocellular carcinoma
(HCC).
Methods: A retrospective study was conducted on patients with BCLC stage A–B HCC who underwent ultraselective cTACE at the Department of Radiology, Bach Mai Hospital, from January 2022 to
December 2023. The cTACE procedure was performed at an ultraselective level, with slow injection of lipiodol–chemotherapy emulsion until portal vein visualization around the tumor was achieved. Portal vein visualization grade, post-embolization syndrome, and major complications were recorded. Treatment response was assessed at 1 month. Local recurrence rates were evaluated at 6 and 12 months.
Results: Thirty-five tumors in 30 patients were included (mean age, 58 ± 9.3 years; mean tumor diameter, 26.5 ± 8.4 mm). During embolization, 6 tumors showed portal vein visualization grade 0, 11
tumors grade 1, and 18 tumors grade 2. No major complications occurred; only mild-to-moderate post-embolization syndrome was observed. The complete response rate according to mRECIST was 97.1% (34/35). Local recurrence rates were 11.8% (4/34) at 6 months and 23.5% (8/34) at 12 months. Tumors with grade 2 portal vein visualization had the lowest recurrence rate (0% at 6 months; 5.6% at 12 months), which was significantly lower compared with grade 0 (60% at 6 months; 80% at 12 months, p < 0.01), but not significantly different compared with grade 1 (9.1% at 6 months; 27.3% at 12 months).
Conclusion: Ultraselective cTACE for early- and intermediatestage HCC achieved high local tumor control and excellent safety. This technique is nearly equivalent to a curative treatment option for small
HCC in patients who are not candidates for surgery or radiofrequency ablation (RFA).