Transarterial Chemoembolisation (TACE) with Degradable Starch Microspheres (DSM) and Anthracycline in Patients with Locally Extensive Hepatocellular Carcinoma (HCC): Safety and Efficacy
To evalutate safety and efficacy of degradable starch microspheres (DSM) as embolic agent in transarterial chemoembolisation (TACE) of unresectable, locally extensive hepatocellular carcinoma (HCC).
Materials and Methods
In this retrospective study, 37 patients with intermediate to advanced HCC treated with ≥ 3 chemoembolisations with doxorubicin/epirubicin and DSM were analysed. Patients were treated with three consecutive chemoembolisations in 4-weekly intervals. Clinical parameters and laboratory findings were obtained from patient records before and after each intervention. Tumour response was assessed after every 3 embolisations by CT/MRI according to modified response evaluation criteria in solid tumours.
Thirty-seven patients with HCC were treated with 177 DSM-TACEs (3–12/patient, mean 4.8). Disease stages according to the Barcelona Clinic Liver Cancer (BCLC) staging system were: 27 × B, 9 × C, 1 × D. Five patients had uninodular, 32 multinodular (23 bilobar) disease. Three patients had portal vein invasion. Apart from one possibly procedure-related grade 3 complication, only grade 1 adverse events occurred. These were pain reacting to analgesics (23%), transient nausea (11%), vomiting (3%) and post-embolisation syndrome (4%). Transient laboratory changes were bone marrow toxicity (29%) and increase in INR (14%), creatinine (8%) or bilirubin (38%). Tumour response was objective response rate 49%, disease control rate 83%. Median survival was 19 months: 22 months for BCLC stage B and 6.7 months for BCLC stages C + D. Responders had a significantly better prognosis than non-responders.
DSM-TACE of HCC is safe even in patients with advanced disease stages. Tumour response and survival rates were encouraging in our series of patients with locally extensive disease.
KeywordsTransarterial chemoembolisation TACE Degradable starch microspheres DSM Hepatocellular carcinoma HCC
This study was not supported by any funding.
Compliance with Ethical Standards
Conflict of interest
Alexander Gross has received travel grants and a speaker honorarium from PharmaCept GmbH (Berlin, Germany). Thomas Albrecht has received travel grants and speaker honoraria from PharmaCept GmbH (Berlin, Germany).
Consent for Publication
The study was approved by the local ethics committee (Ethikkommission der Ärztekammer Berlin).
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. The study was approved by the local ethics committee (Ethikkommission der Ärztekammer Berlin).
Informed consent was obtained from all individual participants included in the study.
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