Skip to main content
SpringerLink
Log in

Transcatheter Arterial Chemoembolization with Epirubicin-Loaded Superabsorbent Polymer Microspheres for 135 Hepatocellular Carcinoma Patients: Single-Center Experience

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the safety, clinical outcomes, and hepatic artery damage after transcatheter arterial chemoembolization (TACE) with epirubicin-loaded superabsorbent polymer microspheres (ELM-TACE) in patients with hepatocellular carcinoma (HCC) in a single center in Japan.

Materials and Methods

This embolic agent is the original form of microspheres, which has the same composition and nature as HepaSpheres. Between May 2007 and June 2009, 135 patients with unresectable HCC who underwent ELM-TACE were enrolled. Embolization through extrahepatic collaterals was performed in 27 (20.0%) patients. Tumor response was evaluated using European Association for the Study of the Liver criteria at 1 and 6 months after initial ELM-TACE.

Results

All procedures were successfully performed. The median number of TACE per patient was 1.7 sessions (range 1–5), and the mean epirubicin dose per session was 19.7 mg (range 2.0–60.0). Local pooling within target tumors was observed during TACE in 34 (25.2%) patients, and in 14 (10.4%) of the patients, gelatin sponge particles were added after the microspheres until each pooling disappeared. No serious adverse events associated with TACE occurred, and the incidence of postembolization syndrome was ≤17.8%. The 1- and 6-month tumor response rates were 56.3 and 52.6%, respectively. The overall 1- and 2-year survival rates were 73.7 and 59.0%, respectively. Among 99 evaluated patients, 90 (90.9%) were found to have no hepatic artery damage after initial ELM-TACE.

Conclusion

ELM-TACE is safe and effective treatment for unresectable HCC and is associated with low frequency of postembolization syndrome and minimal damage to the hepatic artery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. El-Serag HB, Rudolph KL (2007) Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology 132:2557–2576

    Article  PubMed  CAS  Google Scholar 

  2. Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430

    Article  PubMed  CAS  Google Scholar 

  3. Bruix J, Llovet JM (2002) Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 35:519–524

    Article  PubMed  Google Scholar 

  4. Llovet JM, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 37:429–442

    Article  PubMed  CAS  Google Scholar 

  5. Llovet JM, Real MI, Montana X et al (2002) Arterial embolization or chemoembolization verses systemic treatment in patients with unresectable hepatocellular carcinoma: a randomized controlled trial. Lancet 359:1734–1739

    Article  PubMed  Google Scholar 

  6. Brown DB, Cardella JF, Sacks D et al (2009) Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol 20(Suppl 7):S219–S226

    Article  PubMed  Google Scholar 

  7. Satake M, Uchida H, Arai Y et al (2008) Transcatheter arterial chemoembolization (TACE) with lipiodol to treat hepatocellular carcinoma: survey results from the TACE study group of Japan. Cardiovasc Intervent Radiol 31:756–761

    Article  PubMed  Google Scholar 

  8. Cammà C, Schepis F, Orlando A et al (2002) Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology 224:47–54

    Article  PubMed  Google Scholar 

  9. Chang JM, Tzeng WS, Pan HB et al (1994) Transcatheter arterial embolization with or without cisplatin treatment of hepatocellular carcinoma. A randomized controlled study. Cancer 74:2449–2453

    Article  PubMed  CAS  Google Scholar 

  10. Kawai S, Okamura J, Ogawa M et al (1992) Prospective and randomized clinical trial for the treatment of hepatocellular carcinoma: a comparison of lipiodol-transcatheter arterial embolization with and without adriamycin (first cooperative study). The Cooperative Study Group for Liver Cancer Treatment of Japan. Cancer Chemother Pharmacol 31(Suppl):S1–S6

    Article  PubMed  Google Scholar 

  11. Maeda N, Osuga K, Mikami K et al (2008) Angiographic evaluation of hepatic arterial damage after transarterial chemoembolization for hepatocellular carcinoma. Radiat Med 26:206–212

    Article  PubMed  Google Scholar 

  12. Varela M, Real MI, Burrel M et al (2007) Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 46:474–481

    Article  PubMed  CAS  Google Scholar 

  13. Malagari K, Chatzimichael K, Alexopoulou E et al (2008) Transarterial chemoembolization of unresectable hepatocellular carcinoma with drug eluting beads: results of an open-label study of 62 patients. Cardiovasc Interv Radiol 31:269–280

    Article  Google Scholar 

  14. Grosso M, Vignali C, Quaretti P et al (2008) Transarterial chemoembolization for hepatocellular carcinoma with drug-eluting microspheres: preliminary results from an Italian multicenter study. Cardiovasc Intervent Radiol 31:1141–1149

    Article  PubMed  Google Scholar 

  15. Poon RT, Tso WK, Pang RW et al (2007) A phase I/II trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drug-eluting bead. Clin Gastroenterol Hepatol 5:1100–1108

    Article  PubMed  CAS  Google Scholar 

  16. Kettenbach J, Stadler A, Katzler IV et al (2008) Drug-loaded microspheres for the treatment of liver cancer: review of current results. Cardiovasc Intervent Radiol 31:468–476

    Article  PubMed  Google Scholar 

  17. Hong K, Khwaja A, Liapi E et al (2006) New intra-arterial drug delivery system for the treatment of liver cancer: preclinical assessment in a rabbit model of liver cancer. Clin Cancer Res 12:2563–2567

    Article  PubMed  CAS  Google Scholar 

  18. Lewis AL, Gonzalez MV, Leppard SW et al (2007) Doxorubicin eluting beads—1: effects of drug loading on bead characteristics and drug distribution. J Mater Sci Mater Med 18:1691–1699

    Article  PubMed  CAS  Google Scholar 

  19. Lammer J, Malagari K, Vogl T et al (2010) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33:41–52

    Article  PubMed  Google Scholar 

  20. Reyes DK, Vossen JA, Kamel IR et al (2009) Single-center phase II trial of transarterial chemoembolization with drug-eluting beads for patients with unresectable hepatocellular carcinoma: Initial experience in the United States. Cancer J 15:526–532

    Article  PubMed  CAS  Google Scholar 

  21. Osuga K, Hori S, Hiraishi K et al (2008) Bland embolization of hepatocellular carcinoma using superabsorbent polymer microspheres. Cardiovasc Intervent Radiol 31:1108–1116

    Article  PubMed  Google Scholar 

  22. Lacouture ME, Maitland ML, Segaert S et al (2010) A proposed EGFR inhibitor dermatologic adverse event-specific grading scale from the MASCC skin toxicity study group. Support Care Cancer 18:509–522

    Article  PubMed  Google Scholar 

  23. Lewis AL, Gonzalez MV, Lloyd AW et al (2006) DC Bead: in vitro characterization of a drug-delivery device for transarterial chemoembolization. J Vasc Interv Radiol 17:335–342

    Article  PubMed  Google Scholar 

  24. Brown KT, Nevins AB, Getrajdman GI et al (1998) Particle embolization for hepatocellular carcinoma. J Vasc Interv Radiol 9:822–828

    Article  PubMed  CAS  Google Scholar 

  25. Chan AO, Yuen MF, Hui CK et al (2002) A prospective study regarding the complications of transcatheter intraarterial lipiodol chemoembolization in patients with hepatocellular carcinoma. Cancer 94:1747–1752

    Google Scholar 

  26. Shim JH, Park JW, Choi JI et al (2009) Does postembolization fever after chemoembolization have prognostic significance for survival in patients with unresectable hepatocellular carcinoma? J Vasc Interv Radiol 20:209–216

    Article  PubMed  Google Scholar 

  27. Kim JH, Chung JW, Han JK et al (1995) Transcatheter arterial embolization of the internal mammary artery in hepatocellular carcinoma. J Vasc Interv Radiol 6:71–74

    Article  PubMed  CAS  Google Scholar 

  28. Park SI, Lee DY, Won JY, Lee JT (2003) Extrahepatic collateral supply of hepatocellular carcinoma by the intercostal arteries. J Vasc Interv Radiol 14:461–468

    PubMed  Google Scholar 

  29. Won JY, Lee DY, Lee JT et al (2003) Supplemental transcatheter arterial chemoembolization through a collateral omental artery: treatment for hepatocellular carcinoma. Cardiovasc Intervent Radiol 26:136–140

    Article  PubMed  Google Scholar 

  30. Miyayama S, Yamashiro M, Okuda M et al (2010) The march of extrahepatic collaterals: analysis of blood supply to hepatocellular carcinoma located in the bare area of the liver after chemoembolization. Cardiovasc Intervent Radiol 33:513–522

    Article  PubMed  Google Scholar 

  31. Miyayama S, Yamashiro M, Okuda M et al (2010) Hepatocellular carcinoma supplied by the right lumbar artery. Cardiovasc Intervent Radiol 33:53–60

    Article  PubMed  Google Scholar 

  32. Geschwind JF, Ramsey DE, Choti MA et al (2003) Chemoembolization of hepatocellular carcinoma: results of a metaanalysis. Am J Clin Oncol 26:344–349

    PubMed  CAS  Google Scholar 

  33. Ikeda M, Okada S, Yamamoto S et al (2002) Prognostic factors in patients with hepatocellular carcinoma treated by transcatheter arterial embolization. Jpn J Clin Oncol 32:455–460

    Article  PubMed  Google Scholar 

  34. Lladó L, Virgili J, Figueras J et al (2000) A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization. Cancer 88:50–57

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Radiology, GateTower Institute for Image Guided Therapy, 1-Rinku Orai, Izumisano, Osaka, 598-0048, Japan

    Akihiko Seki, Shinich Hori & Kazuya Kobayashi

  2. Department of Internal Medicine, GateTower Institute for Image Guided Therapy, 1-Rinku Orai, Izumisano, Osaka, 598-0048, Japan

    Seizi Narumiya

Authors
  1. Akihiko Seki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shinich Hori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kazuya Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seizi Narumiya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Akihiko Seki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Seki, A., Hori, S., Kobayashi, K. et al. Transcatheter Arterial Chemoembolization with Epirubicin-Loaded Superabsorbent Polymer Microspheres for 135 Hepatocellular Carcinoma Patients: Single-Center Experience. Cardiovasc Intervent Radiol 34, 557–565 (2011). https://doi.org/10.1007/s00270-010-9975-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-010-9975-y

Keywords

Search

Navigation