Clinical Study Of DEB-TACE In The Treatment Of Hepatic Metastases

Background and objective:Malignant tumors develop to the advanced stage,often accompanied by distant distant metastasis.As a blood-rich organ,the liver is one of the most common sites of distant hematogenous metastasis due to its unique blood supply characteristics(hepatic artery and portal vein system),which is common in digestive system tumor liver metastasis.For liver metastases,in the treatment of primary disease,controlling intrahepatic metastases and protecting normal liver tissue can significantly improve the prognosis of patients.The preferred treatment is surgical resection.However,liver metastases are often multiple and difficult to operate.Internal medicine with intravenous systemic chemotherapy has a large adverse reaction and limited efficacy.Interventional therapy is the current mainstream treatment for liver metastases.The main methods are:(1)endovascular intervention: Transactheter arterial chemoembolizati(TAI),transcatheter arterial embolizati(TAE)Transcatheter arterial chemoembolization(TACE);(2)non-vascular interventional therapy: radiofrequency ablation(RFA),microwave ablation,argon-helium cryoablation,radioactive seed implantation.Because the blood supply of liver metastases is mainly from the hepatic artery,TACE stands out in many interventional treatments.However,in clinical applications,conventional arterial chemoembolization(c-TACE)often embolizes tumor vascular beds with emulsions of iodinated oil and chemotherapeutic drugs.Because the iodized oil emulsion is a liquid embolic agent,it has pro-vascular characteristics,and the blood supply to the tumor is easy to cause the embolization is not complete,and the loaded chemotherapy drug is unstable,easy to enter the systemic circulation,and cause adverse reactions,thereby affecting the therapeutic effect of TACE.Drug-loaded microsphere(Drug-eluting bead,DEB)as a new embolic agent can not only effectively embolize the tumor feeding artery,but also has the ability to load chemotherapeutic drugs.The drug loading time is long and stable,and the drug is released slowly.The drug concentration around the tumor tissue is increased,and the tumor has a sustained killing effect.At present,the clinical research on Drug-eluting beads transarterial chemoembolization(DEB-TACE)is mainly focused on the field of primary liver cancer,and there are few reports on the treatment of liver metastases by DEB-TACE.This study focused on the feasibility,safety and efficacy of DEB-TACE in the treatment of hepatic metastases.Materials and methods:Retrospective analysis of clinical data of 54 patients with hepatic metastasis from the Department of Radiology,First Affiliated Hospital of Zhengzhou University,2016.5-2018.Among them,there were 25 males and 6 females in the DEB-TACE group,aged 31-75(59.9±3.26)years,including 17 cases of colorectal cancer liver metastasis,8 cases of gastric cancer liver metastasis,and 6 cases of neuroendocrine tumor liver metastasis.There were 15 males and 8 females in the c-TACE group,aged 27-77(60.1±10.00)years,including 16 cases of colorectal cancer liver metastasis and 7 cases of gastric cancer liver metastasis(See Table 1 for details).All patients were treated with Diagnosis by imaging or pathology.Comparative analysis of the two groups of patients before,1 week after surgery,1 month after surgery,liver and kidney function,blood coagulation function,blood routine and tumor markers and other test indicators.The patients underwent radiography(CT or MRI plain scan + enhancement)at 1 month,3 months,and 6 months after surgery,and compared with patients with modified response evaluation criteria in solid tumors(mRECIST).The short-term efficacy was compared and evaluated.The main indicators were OS and PFS,and observed whether there were serious complications.Result:The preoperative laboratory test indexes of the two groups were compared with 1 week and 1 month after operation.The changes of test indexes at 1 week after operation were mainly manifested in alanine aminotransferase(AST),aspartate aminotransferase(AST)and leukocyte elevation,among which only white blood cells The difference was statistically significant.There was no statistically significant difference between the 1 month postoperatively and the preoperative comparative laboratory tests(See Table 5 for details).There were no significant differences in the preoperative,postoperative,and preoperative and postoperative differences between the two groups of tumor markers(CEA,CA-199)(See Table 6,Table 7 for details).No serious complications occurred in either group.In the DEB-TACE group,the objective response rate(ORR)(CR+PR)was 82.4%,and the control rate(DCR))was 88.2%;the ORR was 52.9% and the DCR was 64.7% at 3 months postoperatively;the ORR was 33.3% and the DCR was 46.7% at 6 months postoperatively.The ORR and DCR of patients with liver metastases were 75.0% at 1 month postoperatively;the ORR was 50.0% and the DCR was 62.5% at 3 months postoperatively;the ORR was 14.3% and the DCR was 28.6% at 6 months postoperatively.In patients with neuroendocrine tumor liver metastasis,the ORR and DCR were 100% at 1 month after DEB-TACE.The ORR and DCR were 83.3% at 3 months after operation.The ORR and DCR were 75% at 6 months after operation.In the c-TACE group,patients with liver metastases from colorectal cancer had an ORR of 68.8% and a DCR of 87.5% at 1 month postoperatively.The ORR was 37.5% and the DCR was 62.5% at 3 months postoperatively.The ORR was 12.5% and the DCR was 25.0%.There was no significant difference in ORR and DCR between the two groups.The ORR and DCR of intrahepatic metastases were 57.1% in patients with liver metastases from 1 month after operation.The ORR was 14.3% and the DCR was 42.9% at 3 months postoperatively.The ORR and DCR were 14.3% after 6 months.There was no statistical difference between ORR and DCR in the group(See Table 8,Table 9,and Table 10 for details.).Conclusion:The short-term efficacy of DEB-TACE in the treatment of liver metastases is certain,and the technology is safe and feasible.May be more advantageous than c-TACE,but long-term efficacy requires further large randomized controlled trials.