Transcatheter arterial chemoembolization for hepatocellular carcinoma in super-elderly patients aged ≥ 85 years

To evaluate the safety of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in super-elderly patients (aged ≥ 85 years).

Materials and Methods: This study included 55 consecutive TACE procedures of 17 treatment-naïve patients aged ≥ 85 years (super-elderly) for HCC from May 2010 through January 2022. Patient information, including age, sex, tumor size, tumor number, Child-Pugh classification, causes of liver diseases, and some blood laboratory parameters were retrospectively obtained. Patients were followed up for clinical symptoms of postembolization syndrome (PES), which was characterized by fever, pain, nausea, and vomiting, and laboratory markers such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) during the hospital stay. Also, the length of hospital stay and TACE-related complications were reviewed.

Results: TACE using powdered cisplatin without lipiodol, epirubicin-lipiodol emulsion, miriplatin-lipiodol suspension, and drug-eluting beads were performed in 11, 20, 15, and 9 cases, respectively. The baseline characteristics of the patients were as follows: age, 86.0 [86.0-88.0 (IQR)]; gender, male/female: 12/5; maximum tumor size, 5.0 (3.4-6.1 cm); tumor number, ≤5 vs. >5: 44/11; Child-Pugh classification, A/B: 54/1; causes of liver diseases, alcohol-related/hepatitis B virus infection/ hepatitis C virus infection C/others: 1/3/5/8. The PES incidence rate was 53% (29/55) (any grade in Common Terminology Criteria for Adverse Events (CTCAE) version 5.0), and no severe PES (grade 3 or above) was observed. AST and ALT increased significantly from 34 (28-41 IU/L) to 89 (60-128 IU/L) (P < 0.001) and from 24 (17-36 IU/L) to 76 (45-144 IU/L) (P < 0.001), and 7 (12%) and 15 (27%) cases were categorized in grade 3 or above using CTCAE criteria, respectively. However, there were no procedure-related complications and TACE-related mortality was 0%. The median length of hospital stay was 6 days.

Conclusion:

Transcatheter arterial chemoembolization for hepatocellular carcinoma in super-elderly patients aged ≥ 85 years may be safe and acceptable.