A Study of Transarterial Chemoembolization in Elderly Patients: An Interview With Daniel B. Brown, MD, FSIR

Older patients are often considered high-risk patients for medical procedures. Interventional oncology clinicians sought to answer the question: is transarterial chemoembolization (TACE) as safe and effective for elderly patients as it is for younger patients? At the 39th annual meeting of the Society of Interventional Radiology, Interventional Oncology 360 spoke with Daniel B. Brown, MD, FSIR, chief of interventional oncology at Vanderbilt University in Nashville, about a retrospective study of the safety and efficacy of TACE in older patients performed at Thomas Jefferson University Hospital in Philadelphia.

Q: Could you describe the need for the study on TACE and elderly patients?

A: Older patients are often considered to be at higher risk during even minimally invasive procedures, let alone surgery. There are surgical series that show that older patients with HCC survive as long as younger patients if they are appropriately selected. The same question comes up with chemoembolization: can older patients tolerate treatment? Sometimes they might need radioembolization, which is also effective, but we wanted to see whether chemoembolization would be effective and safe as well so we went back and reviewed our experience. 

Q: Could you describe the methods for that study?

A: We went through our database at Thomas Jefferson, where I worked from 2007 to 2013. Patients were treated as they would normally have been treated, so it was a real-world study. Groups were defined as under or over the age of 65. The factors that led to cirrhosis and HCC were similar in each group — similar hepatitis C, similar hepatitis B, similar liver function — and they were treated, and as tumors recurred, they were treated again, following time to progression.

Q: And could you give us a bit of a run-down of some of the conclusions?

A: The conclusions were that chemoembolization had equal efficacy on patients over and under the age of 65 with no difference in complications, so it can be performed safely with no greater risk in patients who are over the age of 65. Additionally, the outcomes are statistically similar, meaning we shouldn’t expect any less of an outcome. Patients can be treated like you would treat patients of a younger age, given that the liver functions are adequate to allow treatment.

Q: Are there any other way that these results will translate into practice for interventional oncology clinicians?

A: I think there is some concern about treating older patients and whether they’ll be able to tolerate therapy. Again if you don’t have glass microspheres available in your institution, which is what’s been described for older patients, you may be a little hesitant to treat these patients with chemoembolization. I think this at least gives an idea that these patients can be treated safely and with good efficacy.

Q: Were there any results that you saw that you maybe didn’t expect? 

A: No, it was pretty much what we expected given the retrospective nature of the study. However, we weren’t looking to prove superiority; we wanted to just demonstrate safety and efficacy.

Editor’s note: Disclosure: Dr. Brown has completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. He reports consultancy to Cook Medical and Medtronic. 

Suggested citation: Ford J. A Study of Transarterial Chemoembolization in Elderly Patients: An Interview With Dan Brown, MD. Intervent Onc 360. 2014;2(11):79-80.