Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. May 28, 2017; 9(5): 245-252
Published online May 28, 2017. doi: 10.4329/wjr.v9.i5.245
Transarterial chemoembolization using 40 µm drug eluting beads for hepatocellular carcinoma
Giorgio Greco, Tommaso Cascella, Antonio Facciorusso, Roberto Nani, Rodolfo Lanocita, Carlo Morosi, Marta Vaiani, Giuseppina Calareso, Francesca G Greco, Antonio Ragnanese, Marco A Bongini, Alfonso V Marchianò, Vincenzo Mazzaferro, Carlo Spreafico
Giorgio Greco, Tommaso Cascella, Rodolfo Lanocita, Carlo Morosi, Marta Vaiani, Giuseppina Calareso, Francesca G Greco, Alfonso V Marchianò, Carlo Spreafico, Department of Radiology, Interventional Radiology, Nuclear Medicine and Radiotherapy, National Cancer Institute, 20133 Milan, Italy
Antonio Facciorusso, Gastroenterology Unit, Ospedali Riuniti Foggia, University of Foggia, 71122 Foggia, Italy
Roberto Nani, Antonio Ragnanese, Radiology and Interventional Radiology Unit, Azienda Ospedaliera Giovanni Paolo XXIII, 24128 Bergamo, Italy
Marco A Bongini, Vincenzo Mazzaferro, Hepato-biliary Surgery and Liver Transplantation Unit, National Cancer Institute, 20133 Milan, Italy
Author contributions: Greco G collected data, performed the research, wrote the manuscript and made the revision; Greco G, Cascella T, Lanocita R, Morosi C, Marchianò AV, Spreafico C and Nani R performed TACEs and designed the study; Ragnanese A, Calareso G, Vaiani M and Greco FG collected data; Facciorusso A performed statistical analysis; Bongini MA and Mazzaferro V selected the patients, performed clinical support and follow-up, performed liver transplantation; Greco G and Spreafico C evaluated imaging follow-up; Spreafico C supervised the report.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the National Cancer Institute of Milan.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
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:
Correspondence to: Giorgio Greco, MD, Department of Radiology, Interventional Radiology, Nuclear Medicine and Radiotherapy, National Cancer Institute, Via Giacomo Venezian 1, 20133 Milan, Italy.
Telephone: +39-02-23903384 Fax: +39-02-23902060
Received: December 10, 2016
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.

Keywords: Embozene tandem, Drug eluting beads, Drug eluting bead transarterial chemoembolization, Transarterial chemoembolization, Hepatocellular carcinoma

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.