Lower rates of post-embolization syndrome and fatigue with smaller drug-eluting beads for hepatocellular carcinoma

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Siddharth A Padia, University of Washington Medical Center, Seattle, USA, and colleagues, stated that, although transarterial chemoembolization is a standard treatment for hepatocellular carcinoma, “wide variability in techniques has led to varying practices and results across institutions.”

Therefore the authors aimed to compare the safety and imaging response with 100–300µm and 300–500µm doxorubicion drug-eluting beads for chemoembolization to determine the optimal particle size for the treatment of hepatocellular carcinoma. Padia et al commented: “Refinements in the techniques of chemoembolization with doxorubicin drug-eluting beads may help to improve reproducibility and optimise outcomes.”

Published in the Journal of Vascular and Interventional Radiology, the retrospective study included patients who underwent drug-eluting bead chemoembolization and follow-up for hepatocellular carcinoma between 1 January 2010 and 30 June 2012. The criterion for inclusion in the study was: cases when curative procedure was not an option, Child-Pugh cirrhosis A or B, absence of portal vein thrombosis, absence of extrahepatic disease, and performance status 0 to 2 Eastern Cooperative Oncology Group score (ECOG).

Embolization was performed, according to the authors, with doxorubicin drug-eluting LC Beads (Biocompatibles) and the particle size was determined by the interventional radiologist performing chemoembolization. Sixty one treated tumours were treated in 61 patients and were assessed for response to the drug-eluting beads. Out of these patients 39 (64%) were treated with 100–300µm particles and 22 patients were treated with 300–500µm.

All chemoembolization procedures were successful and there were no deaths related to the procedure. Patients were followed-up at one month and then every three months as outpatient visits and imaging.

“At baseline patients in the 100–300µm and 300–500µm groups had similar tumour size distributions, said Padia et al. “Although no statistically significant differences in tumour response by either the World Health Organization (WHO) or the European Association for the Study of the Liver (EASL) were seen, there were tendencies toward higher rates of complete response by EASL in the 100–300µm group (59% vs. 36.4%, p=0.114).

The authors also concluded that there were significantly lower rates of post-embolization syndrome and fatigue in patients treated with 100–300µm drug-eluting beads for chemoembolization in comparison with the 300–500µm group. However, they added, that “although prospective randomised trials would be ideal, they may not be feasible. These trends lead us to favour smaller particles at this time.”