Transcatheter Treatment of Hepatocellular Carcinoma with Doxorubicin-loaded DC Bead (DEBDOX): Technical Recommendations

Abstract

Tranarterial chemoembolization (TACE) has been established by a meta-analysis of randomized controlled trials as the standard of care for nonsurgical patients with large or multinodular noninvasive hepatocellular carcinoma (HCC) isolated to the liver and with preserved liver function. Although conventional TACE with administration of an anticancer-in-oil emulsion followed by embolic agents has been the most popular technique, the introduction of embolic drug-eluting beads has provided an alternative to lipiodol-based regimens. Experimental studies have shown that TACE with drug-eluting beads has a safe pharmacokinetic profile and results in effective tumor killing in animal models. Early clinical experiences have confirmed that drug-eluting beads provide a combined ischemic and cytotoxic effect locally with low systemic toxic exposure. Recently, the clinical value of a TACE protocol performed by using the embolic microsphere DC Bead loaded with doxorubicin (DEBDOX; drug-eluting bead doxorubicin) has been shown by randomized controlled trials. An important limitation of conventional TACE has been the inconsistency in the technique and the treatment schedules. This limitation has hampered the acceptance of TACE as a standard oncology treatment. Doxorubicin-loaded DC Bead provides levels of consistency and repeatability not available with conventional TACE and offers the opportunity to implement a standardized approach to HCC treatment. With this in mind, a panel of physicians took part in a consensus meeting held during the European Conference on Interventional Oncology in Florence, Italy, to develop a set of technical recommendations for the use of DEBDOX in HCC treatment. The conclusions of the expert panel are summarized.

Chemoembolization for Hepatocellular Carcinoma

“…Care should be taken to avoid sedimentation of the beads in the syringe by rotating the syringes or using a threeway stopcock to gently suspend the beads in the solution. 14 Injection of DEB should be continued until near stasis is observed in the artery directly feeding the tumor (i.e., the contrast column should clear within 2 to 5 heartbeats). At that point, injection must be stopped regardless of the amount of beads that have been actually administered, to avoid reflux of embolic material.…”

Hepatoceliulinės Karcinomos Gydymo Transarterine Chemoembolizacija Doksorubicinu Impregnuotomis Mikrosferomis (Deb Tace) Lietuvos Sveikatos Mokslų Universiteto Ligoninėje Kauno Klinikose Analizė

“…Naudotos 3 dydžių mikrosferos: 40 mm, 75 mm ir 100 mm. Pacientams, kurie atitiko Milano kriterijus (vienas navikas ≤5 cm arba iki trijų židi-nių ≤3 cm), vienos procedūros metu skirta iki 75 mg doksorubicino, tiems, kurie kriterijų neatitiko, dozė buvo iki 150 mg [15]. Į tyrimą įtrauktiems pacientams papildomos embolizacijos kitomis priemonėmis nebuvo taikomos.…”

“…Gydymas nutrauktas pradėjus blogėti buvusiai stabiliai kepenų funkcijai ar klinikinei paciento būklei (ECOG >2). Pacientams, kuriems po dviejų DEB TACE procedūrų radiologiš-kai objektyvus atsakas nepasiektas, trečia procedūra nebuvo skiriama [15].…”

The Roles of Doxorubicin in Hepatocellular Carcinoma

“…Despite DEB offering some advantage, conventional TACE is still being used widely. While recommendations have been published by a panel of experts on the use of DEB-TACE [90], there is still no consensus on how to perform conventional TACE. For instance, there are variants on how the anticancer drug is formulated in Lipiodol.…”