DEB-TACE: Anti-Reflux Versus Endhole Catheters
LOS ANGELES—Using an anti-reflux catheter for drug-eluting bead trans-arterial chemoembolization (DEB-TACE) led to a significantly higher objective response at initial imaging, according to an abstract presented at the annual meeting of the Society of Interventional Radiology. Additionally, explant analysis confirmed higher concentration of beads in the tumor and higher tumor necrosis after using anti-reflux catheters.
The researchers undertook the single-center, retrospective study in order to compare two catheter delivery systems—standard endhole catheters and expandable-tip anti-reflux catheters. Anti-reflux catheters have several potential advantages, including facilitating more uptake of particles delivered to tumors, improving the homogeneity of particle distribution within the tumor, and increasing tumor response rates even in hepatocellular carcinoma (HCC) tumors that are outside transplantation criteria.
The study included treatment-naïve cirrhotic patients with solitary LIRADS 5 HCC tumors that were less than 6.5 cm. Eight-eight patients underwent DEB-TACE over a 2-year period with either endhole catheters (70 patients) or anti-reflux catheters (18 patients). Afterwards, 23 patients went on to receive a transplant, with explant available for analysis.
To assess results, there was blinded radiological review of follow-up images at 1, 3, and 6 months, and mRECIST criteria were used to evaluate tumor response. AST, ALT, and bilirubin values were used to determine toxicity, and explanted livers underwent blinded pathological review for necrosis and distribution of microspheres.
Analysis revealed a significantly greater objective response in the group with anti-reflux catheters (100%) compared with endhole catheters (76.5%). Explants from the anti-reflux group had greater concentrations of beads within the tumor relative to the surrounding tissue than explants from the endhole group. Tumor necrosis was also higher in the anti-reflux liver specimens (89.0 ± 2.2%) versus the endhole specimens (56.1 ± 44.5%).
Additionally, patients treated with anti-reflux catheters had lower AST and ALT at 6 months. Adverse events were similar between the two groups.
The study’s authors commented that the “expandable tip in the AR catheter acts as a one-way valve that preferentially targets tumor tissue.” They added, “Microvalve design can create a temporary local increase in arterial pressure.” The study was limited by its retrospective design, lack of randomization, and selection bias, and the authors hope to pursue a multi-center, randomized controlled trial in the future.
J Titano, A Fischman, R Shrestha, et al. Comparison of response rates and explant analysis between endhole (EH) vs anti-reflux catheters in patients undergoing DEB-TACE for solitary LR-5 HCC tumors. Abstract 131. Presented March 19, 2018 at the Society of Interventional Radiology Meeting. Los Angeles, CA.