Degradable starch microspheres transarterial chemoembolization (DSMs-TACE) in patients with unresectable hepatocellular carcinoma (HCC): long-term results from a single-center 137-patient cohort prospective study

Orlacchio, Antonio; Chegai, Fabrizio; Roma, Silvia; Merolla, Stefano; Bosa, A.; Francioso, S.

doi:10.1007/s11547-019-01093-x

Cited by 27 publications

(30 citation statements)

References 30 publications

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“…Carrying out a selective or super-selective catheterization with a complete embolization of Tumor Feeding Vessels (TFV) correlates with the efficacy of these treatments (Mauri et al, 2016). Permanent occlusion of TFV or an incomplete embolization has effects on tumour stromal microenvironment and induces intra-and intercellular signaling processes counteracting and reversing hypoxia (Carmeliet, 2005;Orlacchio et al, 2020), such as the activation of HIFs (hypoxia-inducible factors) and the subsequent release of vascular endothelial growth factor (VEGF), a promoter of neoangiogenesis, tumour proliferation and metastatic growth (Lencioni et al, 2013). To avoid VEGF overexpression and minimize detrimental effects on liver function, both induced by post-embolization ischemia, the idea of the transient occlusion of tumour feeding arteries (a half-life in vitro of 35-50 min) using DSM was born (Pieper et al, 2015;Schicho et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Degradable Starch Microspheres Transcatheter Arterial Chemoembolization as a Bridging Therapy in Patients with Early Stage Hepatocellular Carcinoma and Child-Pugh Stage B Eligible for Liver Transplant

et al. 2021

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In patients with early-stage hepatocellular carcinoma, awaiting liver transplantation, current guidelines by AASLD and ESMO recommend a bridging therapy with a loco-regional treatment to prevent progression outside transplantation criteria. The standard of care in delaying disease progression has been recognized to be the transarterial chemoembolization. Permanent occlusion of tumor feeding vessels has effects on tumour stromal microenvironment by inducing intra- and intercellular signaling processes counteracting hypoxia, such as the release of vascular endothelial growth factor, a promoter of neoangiogenesis, tumour proliferation and metastatic growth. Among chemoembolization interventions, TACE with degradable starch microspheres represents an alternative to conventional cTACE and DEB-TACE and it minimizes detrimental effects on tumour stromal microenvironment, guaranteeing a transient occlusion of tumour feeding arteries and avoiding VEGF overexpression.Between January 2015 and September 2020, 54 consecutive patients with early-stage hepatocellular carcinoma and Child-Pugh stage B, who had undergone DSM-TACE as a bridging therapy while awaiting liver transplantation, were eligible for the study. A total of 154 DSM-TACE was performed, with a mean number of 2.85 procedures per patient. 18 patients (33.3%) succeeded in achieving liver transplantation, with a mean waiting time-to-transplantation of 11.7 months. The cumulative rates of patients still active on the WL at 6 months were about 91 and 93% when considering overall drop-out and tumour-specific drop-out respectively. Overall survival was about 96% at 6 months and 92% at 12 months. 17 patients experienced adverse events after the chemoembolizations. For patients with HCC in the transplant waiting list and within the Child-Pugh B stage, life expectancy may be dominated by the liver dysfunction, rather than by the tumour progression itself. In this population subset, the choice of LRT is critical because LRT itself could become a dangerous tool that is likely to precipitate liver dysfunction to an extent that survival is shortened rather than prolonged. Hence, the current study demonstrates that DSM-TACE is not far from being an ideal LRT, because it has an excellent safety profile, maintaining an efficacy that guarantees a clear advantage on the dropout rate with respect to the non-operative strategy, thus justifying its use.

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Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Degradable Starch Microspheres Transcatheter Arterial Chemoembolization as a Bridging Therapy in Patients with Early Stage Hepatocellular Carcinoma and Child-Pugh Stage B Eligible for Liver Transplant

et al. 2021

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“…7 Radiology Division, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 8 Department of Radiology, UOC San Severo Hospital, San Severo, Italy. 9 Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.…”

Section: Acknowledgementsmentioning

confidence: 99%

“…Patients who are diagnosed at an early stage without metastasis are eligible for curative treatments, and hence, have a good prognosis in the range of 50-70% survival rate at 5-year [3][4][5][6][7][8]. However, the prognosis is poor when HCC is diagnosed at an advanced stage.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic evaluation and ablation treatments assessment in hepatocellular carcinoma

Granata

Grassi

Fusco³

et al. 2021

Infect Agents Cancer

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This article provides an overview of diagnostic evaluation and ablation treatment assessment in Hepatocellular Carcinoma (HCC). Only studies, in the English language from January 2010 to January 202, evaluating the diagnostic tools and assessment of ablative therapies in HCC patients were included. We found 173 clinical studies that satisfied the inclusion criteria.HCC may be noninvasively diagnosed by imaging findings. Multiphase contrast-enhanced imaging is necessary to assess HCC. Intravenous extracellular contrast agents are used for CT, while the agents used for MRI may be extracellular or hepatobiliary. Both gadoxetate disodium and gadobenate dimeglumine may be used in hepatobiliary phase imaging. For treatment-naive patients undergoing CT, unenhanced imaging is optional; however, it is required in the post treatment setting for CT and all MRI studies. Late arterial phase is strongly preferred over early arterial phase. The choice of modality (CT, US/CEUS or MRI) and MRI contrast agent (extracelllar or hepatobiliary) depends on patient, institutional, and regional factors. MRI allows to link morfological and functional data in the HCC evaluation. Also, Radiomics is an emerging field in the assessment of HCC patients.Postablation imaging is necessary to assess the treatment results, to monitor evolution of the ablated tissue over time, and to evaluate for complications. Post- thermal treatments, imaging should be performed at regularly scheduled intervals to assess treatment response and to evaluate for new lesions and potential complications.

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“…There is reduced post-embolization syndrome with less pain and ischemic damage to the tumor-bearing organ. This makes it ideal for large tumors enabling therapeutic benefits for patients with repeated cycles and better tolerance [32,33] .…”

Section: Radio-opaque Microspheres -Dc or Lc Bead Lumimentioning

confidence: 99%

Technical update on transcatheter arterial chemoembolization

Puppala¹

2019

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Transcatheter arterial chemoembolization has become an established drug delivery system for palliative or bridging treatment of hepatocellular carcinoma. Over the last two decades, various research and developments have taken place to improve the transcatheter arterial chemoembolization procedure from both a clinical and a technical perspective. This review article aims to provide an update on the technical developments over the last decade.

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Degradable starch microspheres transarterial chemoembolization (DSMs-TACE) in patients with unresectable hepatocellular carcinoma (HCC): long-term results from a single-center 137-patient cohort prospective study

Cited by 27 publications

References 30 publications

Safety and Efficacy of Degradable Starch Microspheres Transcatheter Arterial Chemoembolization as a Bridging Therapy in Patients with Early Stage Hepatocellular Carcinoma and Child-Pugh Stage B Eligible for Liver Transplant

Safety and Efficacy of Degradable Starch Microspheres Transcatheter Arterial Chemoembolization as a Bridging Therapy in Patients with Early Stage Hepatocellular Carcinoma and Child-Pugh Stage B Eligible for Liver Transplant

Diagnostic evaluation and ablation treatments assessment in hepatocellular carcinoma

Technical update on transcatheter arterial chemoembolization

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