Doxorubicin‑eluting beads versus combined conventional transarterial chemoembolization and percutaneous alcohol injection in the treatment of large hepatocellular carcinoma

Introduction Hepatocellular carcinoma (HCC) is a primary tumor of the liver, which usually develops in the setting of chronic liver disease, particularly in patients with chronic hepatitis B and hepatitis C. Current guidelines recommend transarterial chemoembolization (TACE) as the standard treatment of Barcelona Clinic Liver Cancer‑B patients. The aim of this work is to compare the efficacy, safety, feasibility, and cost‑effectiveness of drug‑eluting bead (DEB)‑TACE versus combined conventional transarterial chemoembolization (c‑TACE)+percutaneous ethanol injection (PEI) for improving the outcome of large HCC. Patients and methods In all, 75 patients with large HCC were included in this study: 30 patients were treated by combined c‑TACE + PEI and 45 patients were treated by DEB‑TACE. Results By comparison of the results of the combined c‑TACE + PEI group with the DEB‑TACE group, there was no significant difference in tumor response, with better results in the combined c‑TACE + PEI group and significant decrease in the median value of the serum level of α‑fetoprotein after treatment among patients treated with combined c‑TACE + PEI (P = 0.004), and a statistically significant difference in the median value after treatment between the two groups (P = 0.036). Conclusion Results of combined c‑TACE + PEI and DEB‑TACE are comparable, but the cost of a DEB‑TACE session is three times that of c‑TACE + PEI, and thus cost‑effectiveness analyses recommend the use of combined c‑TACE + PEI (less cost) in the treatment of large HCC; in addition, there was a significant reduction in the level of α‑fetoprotein after combined c‑TACE+PEI treatment.