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World J Gastroenterol. Jan 14, 2018; 24(2): 161-169
Published online Jan 14, 2018. doi: 10.3748/wjg.v24.i2.161
Drug-eluting beads transarterial chemoembolization for hepatocellular carcinoma: Current state of the art
Antonio Facciorusso
Antonio Facciorusso, Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia 71122, Italy
Author contributions: Facciorusso A designed the study and wrote the paper.
Conflict-of-interest statement: None of the authors have received fees for serving as a speaker or are consultant/advisory board member for any organizations. None of the authors have received research funding from any organizations. None of the authors are employees of any organizations. None of the authors own stocks and/or share in any organizations. None of the authors own patents.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonio Facciorusso, MD, PhD, Assistant Professor, Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Viale L.Pinto 1, Foggia 71100, Italy. antonio.facciorusso@virgilio.it
Telephone: +39-88-1732154 Fax: +39-88-1732135
Received: October 26, 2017
Peer-review started: October 27, 2017
First decision: November 21, 2017
Revised: December 16, 2017
Accepted: December 20, 2017
Article in press: December 20, 2017
Published online: January 14, 2018
Abstract

Transarterial chemoembolization (TACE) represents the current gold standard for hepatocellular carcinoma (HCC) patients in intermediate stage. Conventional TACE (cTACE) is performed with the injection of an emulsion of a chemotherapeutic drug with lipiodol into the artery feeding the tumoral nodules, followed by embolization of the same vessel to obtain a synergistic effect of drug cytotoxic activity and ischemia. Aim of this review is to summarize the main characteristics of drug-eluting beads (DEB)-TACE and the clinical results reported so far in the literature. A literature search was conducted using PubMed until June 2017. In order to overcome the drawbacks of cTACE, namely lack of standardization and unpredictability of outcomes, non-absorbable embolic microspheres charged with cytotoxic agents (DEBs) have been developed. DEBs are able to simultaneously exert both the therapeutic components of TACE, either drug-carrier function and embolization, unlike cTACE in which applying the embolic agent is a second moment after drug injection. This way, risk of systemic drug release is minimal due to both high-affinity carrier activity of DEBs and absence of a time interval between injection and embolization. However, despite promising results of preliminary studies, clear evidence of superiority of DEB-TACE over cTACE is still lacking. A number of novel technical devices are actually in development in the field of loco-regional treatments for HCC, but only a few of them have entered the clinical arena. In absence of well-designed randomized-controlled trials, the decision on whether use DEB-TACE or cTACE is still controversial.

Keywords: Embolization, Doxorubicin, Conventional, Hepatocarcinoma, Liver cancer, Survival

Core tip: Aim of this review is to summarize the main characteristics and the clinical results of drug-eluting beads (DEB)-transarterial chemoembolization (TACE). To obviate to the limitations of cTACE, non-absorbable embolic microspheres charged with cytotoxic agents (DEBs) have been developed. DEBs are able to simultaneously exert both the therapeutic components of TACE, either drug-carrier function and embolization. This way, risk of systemic drug release is minimal. However, despite promising results of preliminary studies, clear evidence of superiority of DEB-TACE over cTACE is still lacking. In absence of well-designed randomized-controlled trials, the decision on whether use DEB-TACE or cTACE is still controversial.