Published online May 28, 2017. doi: 10.4329/wjr.v9.i5.245
Peer-review started: December 13, 2016
First decision: January 16, 2017
Revised: February 23, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: May 28, 2017
To assess the safety and efficacy of transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) using a new generation of 40 μm drug eluting beads in patients not eligible for curative treatment.
Drug eluting bead TACE (DEB-TACE) using a new generation of microspheres (embozene tandem, 40 μm) preloaded with 100 mg of doxorubicin was performed on 48 early or intermediate HCC patients with compensated cirrhosis. Response to therapy was assessed with Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST) guidelines applied to computed tomography or magnetic resonance imaging. Eleven out of the 48 treated patients treated progressed on to receive liver orthotopic transplantation (OLT). This allowed for histological analysis on the treated explanted nodules.
DEB-TACE with 40 μm showed a good safety profile without major complications or 30-d mortality. The objective response rate of treated tumors was 72.6% and 26.7% according to mRECIST and RECIST respectively. Histological examination in 11 patients assigned to OLT showed a necrosis degree > 90% in 78.6% of cases. The overall time to progression was 13 mo (11-21).
DEB-TACE with 40 μm particles is an effective treatment for the treatment of HCC in early-intermediate patients (Barcelona Clinic Liver Cancer stage A/B) with a good safety profile and good results in term of objective response rate and necrosis.
Core tip: This is the first study exploring the safety and efficacy of 40 μm drug eluting bead transarterial chemoembolization for the treatment of hepatocellular carcinoma (HCC) in a series of 48 patients not suitable for ablation or surgical therapies. The use of microspheres smaller than 100 μm is not common practice in the western countries due to skepticism and fear of non-target embolization. Our aim is to present our initial experiences when treating with smaller microspheres so we all can test the potential advantages inherent to them and evaluate the effectiveness in the treatment of HCC nodules.