Value of Noncontrast CT Immediately after Transarterial Chemoembolization of Hepatocellular Carcinoma with Drug-eluting Beads

Golowa, Y.; Cynamon, Jacob; Reinus, John F.; Kinkhabwala, Milan; Abrams, M. C.; Jagust, M.; Chernyak, Victoria; Kaubisch, Andreas

doi:10.1016/j.jvir.2012.04.020

Cited by 26 publications

(17 citation statements)

References 18 publications

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“…Golowa et al[38] showed that DEBDOX mixed with contrast medim helps demonstrates the precise distribution and uptake of the chemotherapeutic agent without disrupting the treatment response evaluation. The contrast medium enabled visualization of the treated tumor due to the increased attenuation, similar to that of lipiodol.…”

Section: Evaluating the Treatment Response To DC Beads Tacementioning

confidence: 99%

Transarterial chemoembolization with drug-eluting beads in hepatocellular carcinoma

Nam¹,

Jang²,

Song³

2016

WJG

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Transarterial chemoembolization (TACE) is a widely used standard treatment for patients with hepatocellular carcinoma (HCC) who are not suitable candidates for curative treatments. The rationale for TACE is that intra-arterial chemotherapy using lipiodol and chemotherapeutic agents, followed by selective vascular embolization, results in a strong cytotoxic effect as well as ischemia (conventional TACE). Recently, drug-eluting beads (DC Beads®) have been developed for transcatheter treatment of HCC to deliver higher doses of the chemotherapeutic agent and to prolong contact time with the tumor. DC Beads® can actively sequester doxorubicin hydrochloride from solution and release it in a controlled sustained fashion. Treatment with DC Beads® substantially reduced the amount of chemotherapeutic agent that reached the systemic circulation compared with conventional, lipiodol-based regimens, significantly reducing drug-related adverse events. In this article, we describe the treatment response, survival, and safety of TACE used with drug-eluting beads for the treatment of HCC and discuss future therapeutic possibilities.

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Section: Evaluating the Treatment Response To DC Beads Tacementioning

confidence: 99%

Transarterial chemoembolization with drug-eluting beads in hepatocellular carcinoma

Nam¹,

Jang²,

Song³

2016

WJG

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“…As the beads themselves are not radiodense, there is no way of locating their exact location; but instead, it has become commonplace to use the phenomenon of trapped soluble contrast retention as a surrogate for assessing successful devascularization [12, 13]. This requires a CT scan to be performed within the first 6 hours of bead administration, as the process of devitalising the tumor means that some of the contrast agent that has been delivered in conjunction with the beads becomes resident in the embolized tissue and its elimination by the usual wash-out mechanisms is retarded.…”

Section: Introductionmentioning

confidence: 99%

Characterization of a novel intrinsically radiopaque Drug-eluting Bead for image-guided therapy: DC Bead LUMI™

Ashrafi

Tang

Britton

et al. 2017

Journal of Controlled Release

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We have developed a straightforward and efficient method of introducing radiopacity into Polyvinyl alcohol (PVA)-2-Acrylamido-2-methylpropane sulfonic acid (AMPS) hydrogel beads (DC Bead™) that are currently used in the clinic to treat liver malignancies. Coupling of 2,3,5-triiodobenzaldehyde to the PVA backbone of pre-formed beads yields a uniformly distributed level of iodine attached throughout the bead structure (~150 mg/mL) which is sufficient to be imaged under standard fluoroscopy and computed tomography (CT) imaging modalities used in treatment procedures (DC Bead LUMI™. Despite the chemical modification increasing the density of the beads to ~1.3 g/cm3 and the compressive modulus by two orders of magnitude, they remain easily suspended, handled and administered through standard microcatheters. As the core chemistry of DC Bead LUMI™ is the same as DC Bead™, it interacts with drugs using ion-exchange between sulfonic acid groups on the polymer and the positively charged amine groups of the drugs. Both doxorubicin (Dox) and irinotecan (Iri) elution kinetics for all bead sizes evaluated were within the parameters already investigated within the clinic for DC Bead™. Drug loading did not affect the radiopacity and there was a direct relationship between bead attenuation and Dox concentration. The ability (Dox)-loaded DC Bead LUMI™ to be visualized in vivo was demonstrated by the administration of into hepatic arteries of a VX2 tumor-bearing rabbit under fluoroscopy, followed by subsequent CT imaging.

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“…Success of embolization is determined by monitoring antegrade flow of soluble contrast medium to reach the desired flow-based procedural endpoint of reduced or nearly static blood flow 2 . Soluble contrast retention in the tumor and/or lack of tumor contrast enhancement due to the embolization, monitored with cone-beam computed tomography (CBCT) or multidetector CT (MDCT), may be employed to indicate coverage or completeness of treatment and to predict response and recurrence 3 - 6 . However, the true bead location is unknown and only inferred from indirect and temporary signs as soluble contrast medium washes out 3 - 6 .…”

Section: Introductionmentioning

confidence: 99%

A Novel Inherently Radiopaque Bead for Transarterial Embolization to Treat Liver Cancer - A Pre-clinical Study

Durán¹,

Sharma

Dreher

et al. 2016

Theranostics

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Purpose: Embolotherapy using microshperes is currently performed with soluble contrast to aid in visualization. However, administered payload visibility dimishes soon after delivery due to soluble contrast washout, leaving the radiolucent bead's location unknown. The objective of our study was to characterize inherently radiopaque beads (RO Beads) in terms of physicomechanical properties, deliverability and imaging visibility in a rabbit VX2 liver tumor model.Materials and Methods: RO Beads, which are based on LC Bead® platform, were compared to LC Bead. Bead size (light microscopy), equilibrium water content (EWC), density, X-ray attenuation and iodine distribution (micro-CT), suspension (settling times), deliverability and in vitro penetration were investigated. Fifteen rabbits were embolized with either LC Bead or RO Beads + soluble contrast (iodixanol-320), or RO Beads+dextrose. Appearance was evaluated with fluoroscopy, X-ray single shot, cone-beam CT (CBCT).Results: Both bead types had a similar size distribution. RO Beads had lower EWC (60-72%) and higher density (1.21-1.36 g/cc) with a homogeneous iodine distribution within the bead's interior. RO Beads suspension time was shorter than LC Bead, with durable suspension (>5 min) in 100% iodixanol. RO Beads ≤300 µm were deliverable through a 2.3-Fr microcatheter. Both bead types showed similar penetration. Soluble contrast could identify target and non-target embolization on fluoroscopy during administration. However, the imaging appearance vanished quickly for LC Bead as contrast washed-out. RO Beads+contrast significantly increased visibility on X-ray single shot compared to LC Bead+contrast in target and non-target arteries (P=0.0043). Similarly, RO beads demonstrated better visibility on CBCT in target arteries (P=0.0238) with a trend in non-target arteries (P=0.0519). RO Beads+dextrose were not sufficiently visible to monitor embolization using fluoroscopy.Conclusion: RO Beads provide better conspicuity to determine target and non-target embolization compared to LC Bead which may improve intra-procedural monitoring and post-procedural evaluation of transarterial embolization.

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Value of Noncontrast CT Immediately after Transarterial Chemoembolization of Hepatocellular Carcinoma with Drug-eluting Beads

Cited by 26 publications

References 18 publications

Transarterial chemoembolization with drug-eluting beads in hepatocellular carcinoma

Transarterial chemoembolization with drug-eluting beads in hepatocellular carcinoma

Characterization of a novel intrinsically radiopaque Drug-eluting Bead for image-guided therapy: DC Bead LUMI™

A Novel Inherently Radiopaque Bead for Transarterial Embolization to Treat Liver Cancer - A Pre-clinical Study

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