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Vol. 57. Issue 6.
Pages 496-504 (November - December 2015)
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Vol. 57. Issue 6.
Pages 496-504 (November - December 2015)
Original article
Trans-arterial chemoembolization with doxorubicin-eluting particles versus conventional trans-arterial chemoembolization in unresectable hepatocellular carcinoma: A study of effectiveness, safety and costs
Quimioembolización transarterial con partículas liberadoras de doxorrubicina frente a quimioembolización transarterial convencional en carcinomas hepatocelulares irresecables: un estudio de eficacia, seguridad y gastos
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J.E. Megías Vericata,
Corresponding author
megias_jua@gva.es

Corresponding author.
, R. García Marcosb, E. López Brizc, F. Gómez Muñozd, J. Ramos Ruizc, J.J. Martínez Rodrigob, J.L. Poveda Andrésc
a Department of Pharmacy, Drug Clinical Area, Hospital Universitari i Politècnic La Fe and Instituto de Investigación Sanitaria La Fe, Valencia, Spain
b Department of Radiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
c Department of Pharmacy, Drug Clinical Area, Hospital Universitari i Politècnic La Fe, Valencia, Spain
d Department of Radiology, Hospital Clínic, Barcelona, Spain
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Tables (4)
Table 1. Basal characteristics of the study population. Comparison between cTACE and DEB-TACE using the χ2 test and the Student t-test.
Table 2. Overall survival and disease progression-free survival at 5 years (expressed in months). Comparison between cTACE and DEB-TACE using the Kaplan–Meier method and the log-rank test.
Table 3. Clinical state associated with the TACE intervention. Comparison between cTACE and DEB-TACE using the χ2 test.
Table 4. Cost of the interventions (in Euros and US dollars). Comparison between cTACE and DEB-TACE using the Student t-test.
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Abstract
Objectives

To compare the effectiveness, survival and cost in patients with unresectable hepatic cell carcinoma (HCC) treated with trans-arterial chemoembolization using doxorubicin-eluting beads (DEB-TACE) versus conventional TACE (cTACE) in clinical practice.

Materials and methods

This single-centered retrospective observational study compared 60 consecutive HCC unresectable patients: 30 were treated with DEB-TACE and 30 used cTACE. Comparisons were with χ2 test, Student t-test, and Kaplan–Meier method.

Results

Of the 60 patients with HCC in non-curative stage, baseline characteristics were similar for both groups of treatment, and of these we observed lower survival in male patients and those who had hepatitis C virus (p=0.014 and p=0.003, respectively). No statistically significant differences were observed as a function of treatment employed with respect to overall survival (OS) at 5 years (29.99 months; 95%CI: 21.38–38.60 versus 30.67 months; 95%CI: 22.65–38.70; p=0.626) and progression free survival (PFS) median of 11.57 months (95%CI: 0.97–22.18) versus 12.80 months (95%CI: 0.00–32.37; p=0.618). The median length of hospital admission was 2.6 and 5.4 days (p<0.001) for DEB-TACE and cTACE, respectively. Toxicities grade 2–4 were higher in cTACE group (54 versus 31; p<0.001). The cost of the treatment was 1581 € for DEB-TACE and 514.63 € for cTACE. The overall mean cost of intervention was 3134 € and 3694.35 €, respectively (p=0.173).

Conclusions

Chemoembolization in patients with unresectable HCC achieved OS close to 30 months at 5 years, independent of the technique employed. Similar overall costs but better tolerance of the DEB-TACE justified the higher costs of the procedure.

Keywords:
Trans-arterial chemoembolization
Doxorubicin-eluting beads
Unresectable hepatic cell carcinoma
Effectiveness
Survival
Toxicity
Cost
Resumen
Objetivo

Comparar la efectividad, supervivencia y coste de la quimioembolización transarterial con partículas liberadoras de doxorrubicina (DEB-TACE) y la quimioembolización convencional (cTACE) en pacientes con carcinoma hepatocelular (CHC) irresecable.

Material y métodos

Estudio unicéntrico, observacional y retrospectivo que comparó 60 pacientes con CHC irresecable separados en dos grupos comparables de 30 pacientes tratados con DEB-TACE y otros 30 con cTACE. Se realizaron las pruebas de χ2 y t de Student, y se utilizó el método de Kaplan Meier.

Resultados

La supervivencia fue menor en hombres y en pacientes con hepatitis C (p=0,014 y p=0,003, respectivamente). No hubo diferencias estadísticamente significativas en la supervivencia global a los 5 años (29,99 meses; IC del 95%: 21,38–38,60 y 30,67 meses; IC del 95%: 22,65–38,70; p=0,626) y la supervivencia libre de progresión (mediana: 11,57 meses; IC del 95%: 0,97–22,18 y 12,80 meses; IC del 95%: 0,00–32,37; p=0,618). El tiempo medio de ingreso fue de 2,6 y 5,4 días (p<0,001) para DEB-TACE y cTACE, respectivamente. La toxicidad grado 2–4 fue superior en el grupo cTACE (54 y 31; p<0,001). El coste del tratamiento fue de 1.581 € con DEB-TACE y de 514,63 € con cTACE. El coste total medio fue de 3.134 € y 3.694,35 €, respectivamente (p=0,173).

Conclusión

La quimioembolización en pacientes con CHC irresecable tiene una supervivencia global cercana a 30 meses a los 5 años, independientemente de la técnica empleada. Los costes globales son similares, aunque la mejor tolerancia de la DEB-TACE justifica el mayor coste del procedimiento.

Palabras clave:
Quimioembolización transarterial
Partículas liberadoras de doxorrubicina
Carcinoma hepatocelular irresecable
Efectividad
supervivencia
Toxicidad
Coste

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