Does DEE TACE Outperform Transarterial Embolization for Treating Renal Cell Carcinoma?

A new study suggests that drug-eluting embolic agent (DEE) transarterial chemoembolization is both safe and has a significantly greater cytoreductive effect than transarterial embolization (TAE) for treating localized renal cell carcinoma (RCC).

In a prospective, randomized trial that took place between 2012 and 2015, researchers recruited 12 patients with RCC that was confirmed via biopsy and who were candidates for nephron-sparking surgery or radical nephrectomy. The patients had a mean tumor size of 3.2 cm ± 0.62 and were randomized to undergo either DEE transarterial chemoembolization or TAE prior to their surgery.

With a microcatheter, the particles were injected selectively into arteries feeding the tumor. To assess patients’ response, microscopy of excised tumors and computed tomography (CT) according to modified Response Evaluation Criteria In Solid Tumors was used.

Results from CT evaluation showed a significantly higher degree of necrosis with DEE (88.3%) transarterial chemoembolization, compared with TAE (29.4%). Comparable outcomes were seen with histopathologic evaluation, where DEE transarterial chemoembolization had an average necrosis rate of 87.5%, while TAE had 26%. There were no major complications reported in either group of patients, and the necrosis percentage results from microscopy were linked with the radiologic results.

Despite the results, DEE transarterial chemoembolization remains a palliative technique, the researchers said. They reported that microscopy detected viable tumor cells even when total tumor necrosis was seen on CT.

“Therefore, it is imperative to state that percutaneous thermal ablation is a curative treatment and should always be used as first-line therapy in inoperable patients. Long-term followup after DEE transarterial chemoembolization is warranted,” the authors wrote. They added, “The possibility of repeating DEE transarterial chemoembolization to achieve an cumulative effect also needs to be investigated.”

Reference

Karalli A, Ghaffarpour R, Axelsson R, et al. Transarterial chemoembolization of renal cell carcinoma: a prospective controlled trial. J Vasc Interv Radiol. 2017 Sep 22. pii: S1051-0443(17)30748-0.