TARE vs TACE for Hepatocellular Carcinoma and NET patients
TheincidenceofHepatocellularCarcinomaorHCChasbeenincreasingoverthepastseveral yearsandseveralstudieshaveprojectedthattheincidenceofHCCwillcontinuetoriseinthe comingyears.
TransarterialChemoembolisationorTACEhasbeentheinitialtreatmentmodalityforHCCand hasahugebodyofevidencefromseveralstudiesandclinicaltrials.Therefore,forlongTACE hasbeenapreferredtreatmentalgorithmforunresectableHCC.
However,astheexperienceofTransarterialRadioembolisationorTAREhasevolved,itis playinganincreasinglyimportantroleinthetreatmentofunresectableHCC.Studiesandtrials haveshownthatTAREhasmanypotentialadvantagesoverTACEandthereisnowsubstantial evidencetofavorTAREoverTACE.
The many potential advantages of TARE when compared with TACE are as below:
o Severalstudieshaveshownastatisticallysignificantoverallsurvivaladvantagewith TAREascomparedtoTACE.
o TAREhasbetterhealth-relatedquality-of-lifemetricsandtoxicityprofilewhen comparedwithTACE.
o TAREasamuchwiderrangeofapplications,includinguseinpatientswithmore advancedliverdisease,multi-focaldisease,vascularinvasionandportalvein thrombosis.Actually,TAREismoresuitableforpatientsofHCCwithportalvein thrombosisbecauseofthesmallsizeofTAREparticleswhencomparedwithTACE, whichtendstoinducemoreischemiaandnecrosis.
o Studieshavealsoshownamuch-lowerriskofpost-embolisationsyndromewith TAREascomparedwithTACE.
o Intermsofside-effects,TAREisoverallwell-tolerated,whereaspost-TACE,thereis deteriorationoftheliverfunctioncoupledwithpainandfever.
o Inpatientswithearly-stageHCCandpreservedliverfunctionwhoarenotcandidates forradiofrequencyablation,TAREprovidesbetterresponserates,tumorcontroland survivaloutcomes.
o InNeuroendocrineTumor(NET)patientswithmultiplelesionsinboththelobesof theliver,TAREisapreferredmodalityandTACEisnotrecommendedatall.
o Also,inNETpatientswherethetumordoesnotexpresssomatostatinreceptors, TAREisamuchbettertreatmenttechniqueascomparedtoTACE.
o Whenitcomestocost,theupfrontcostofasingleTAREsessionismuchhigher(at leasttwotothreetimeshigher)thanthecostofasingleTACEsession.However, consideringthecostofhospitaladmission,paincontrol,treatmentmultiplicityand toxicity,theoverallcost-effectivenessofTAREislikelytobesuperiortoTACEin patientswithunresectableHCC.
Intermsofoverallsurvivalanddelayofprogressioninpatientswithunresectable HCC, TARE isasefficaciousasTACE,howeverTAREhasanevolvingroletoplayinthe treatmentofHCCwithmoreadvancedliverdisease,multi-focaldisease,vascularinvasionand portalveinthrombosis.Apartfromthesereasons,amorefavorableside-effectsprofileandcost aretheotherpotentialadvantagesofTAREascomparedtoTACE.
IntermsofoverallsurvivalanddelayofprogressioninpatientswithunresectableHCC,TAREis asefficaciousasTACE,howeverTAREhasanevolvingroletoplayinthetreatmentofHCCwith moreadvancedliver disease,multi-focaldisease,vascularinvasionandportalveinthrombosis.Apartfromthese reasons,amorefavorableside-effectsprofileandcostaretheotherpotentialadvantagesof TAREascomparedtoTACE.