Application of DC Beads in Hepatocellular Carcinoma: Clinical and Radiological Results of a Drug Delivery Device for Transcatheter Superselective Arterial Embolization

Abstract

Aim: Application of a drug delivery device for transarterial chem-oembolization (TACE) in patients with hepatocellular carcinoma (HCC). Clinical and radiological treatment assessment. Patients and Methods: 24 patients with liver cirrhosis and uni- or multifocal HCC underwent TACE with doxorubicin beads (DC Bead^TM). The underly-ing cause of liver cirrhosis was hepatitis (A: n = 7; B: n = 10) or alco-hol consumption (n = 7). Patients presented with Child Pugh stage A (n = 15) and B (n = 9). The mean intrahepatic tumor size, consid-ering the sum of diameters of all lesions treated, was 3.83 cm (±2.4). Liver function and hematological parameters were docu-mented before and after each TACE. Magnetic resonance imaging (MRI) was performed before and 4 weeks after TACE. The T1-w 3D volume-interpolated breathhold exam (VIBE) sequence was applied for evaluation of the therapy response. Results: 24 patients received a total number of 69 TACE treatments with DC beads (mean dose 160 mg). The elevation of liver function parameters after treat-ment did not affect the patients’ clinical condition. The T1-w VIBE sequence proved very valuable for assessment of the intrahepatic tumor spread. Post-contrast images enabled delineation of the viable HCC lesions, hence facilitating the selective transcatheter ap-proach. The tumor marker a-fetoprotein (AFP), available in 19/24 patients, dropped from 347.5 to 299.5 ng/ml, without being a relia-ble predictor of treatment response. A decrease of tumor size after TACE from 3.83 (±2.40) to 3.01 cm (±2.67; p < 0.0001) was evident on the T1w-VIBE sequences. The mean follow-up period was 30 months. At the time of data analysis, 10 (42%) out of 14 patients were alive. Conclusion: TACE with DC beads in HCC offers a safe and efficient treatment resulting in tumor response within a very short time.

Transarterial Chemoembolisation Using Doxorubicin Beads for Unresectable Hepatocellular Carcinoma

“…Although one always considers optimistic resultsofreportedphaseIItrialswithadegreeofcaution,both ofthesestudiesreported12monthsurvivalinexcessof90% and2yearsurvivalwellabove80% [7,8].Thepresentstudy by Sadick and colleagues [1], although retrospective in its analysisandonasimilarlysmallpatientpopulation,reinforces the outcome data of the earlier reports, while treatment relatedadverseeventsremainrelativelyfew.Interestingly,8of 14patientswhosubsequentlydiedfollowingDCbeadTACE, succumbedbecauseofcirrhosisrelatedhepaticfailure,while theirtumoursremainedstable.…”

“…However, these early results are both interestingandpromisinganddoneedtobefollowedup.Currentlyanumberoftrialproposalsareunderdiscussion.Thisis probablymostsignificantforpatientswhosediseaseisbeyond resectionortransplantation,inwhomweshouldseektoexaminethepossiblecombinationofDCbeadTACEwithsystemic sorafenib. The second group of patients who may very well benefitfromthistreatmentstrategyarethoseonthewaiting listfororthotopiclivertransplantation,whereDCbeadTACE mayofferaprolongationofthebridgetotransplantationwhile ThearticlebySadickandcolleagues [1]onTACEusingdoxorubicin (DC) beads for hepatocellular carcinoma (HCC) in this issue of OnkOlOgie is timely. HCC is a major global healthcare problem and is increasing in incidence.…”

Transcatheter Treatment of Hepatocellular Carcinoma with Doxorubicin-loaded DC Bead (DEBDOX): Technical Recommendations

“…Two other trials reported higher rates of tumor response and longer time to progression for the loaded DC Bead as compared to a bland embolic microsphere with similar characteristics [27, 28]. As a result of these investigations, DEBDOX has been increasingly used as the first-line transcatheter treatment for HCC [29–32]. …”

The Efficiency of Transarterial Chemoembolization with Drug-Eluting Beads in Hepatocellular Carcinoma

“…In the literature, it was reported in 1.8-3.7% of patients across treatments, and found to correlate with the extent of embolization; therefore, it was considered to be the result of inadvertent embolization (26,29). Post-procedural transient elevation of liver enzymes has also been reported in many TACE studies (27,29). In our research, although there was a statistically significant elevation of liver enzymes 3 days postembolization, there were no statistically significant differences between baseline and 1 month after the procedure.…”