Using Epirubicin-loaded DC Beads® for Superselective Embolisation of Liver Tumours – Initial Experiences
Using Epirubicin-loaded DC Beads® for Superselective Embolisation of Liver Tumours – Initial Experiences
Hepatocellular carcinoma (HCC) is one of the leading causes of death worldwide, with a peak incidence in Asian countries. Unfortunately, by the time of diagnosis the disease is often so far advanced that the only curative treatment so far – surgery – cannot be performed in the majority of patients. In the past, several treatment strategies were developed to improve the quality and duration of life of patients suffering from HCC. These strategies included radiofrequency (RFA) and ethanol (PAI) ablation,1 laser interstitial tumour therapy (LIT),2 percutaneous alcohol injection (PAI) and transarterial chemoembolisation (TACE).3–6
In contrast to ablative procedures such as RFA, PAI and LIT, TACE is mainly suitable for the treatment of primary liver tumours such as HCC, which are predominantly supplied by branches of the hepatic arteries. Thus, it is possible to achieve a high concentration of antiproliferative drugs within the tumour in contrast to conventional intravenous (IV) chemotherapy.7,8 Due to the dual blood supply of the liver, normal tissue is not altered too much by this therapeutic strategy. Numerous protocols have been published describing the pros and cons of different antiproliferative drugs (including cisplatin, doxurubicin, epirubicin and mitomycin C) either alone or in combination with lipiodol. Furthermore, the use of additional embolic agents such as polyvinyl alcohol (PVA) particles or Gelfoam has been advocated in order to induce local hypoxia.9,10 The major disadvantage of conventional TACE is that the intratumoral concentration of the drug vastly decreases by the time it is washed out.
Drug-eluting Beads
Recently, microspheres (DC Beads®, Biocompatibles, UK), a sulfonate modified, PVA-based embolisation agent that can be labelled in the angio suite on site by the interventional radiologist with antineoplastic drugs such as doxrubicin or irinotecan, came onto the market.11,12 Using those particles provides two major advantages over conventional TACE. The drug charged to the particles is released to the surrounding tissue continuously in the first 10–12 days. This results not only in a higher overall intratumoral drug dose, but also in a longer period of drug application so that tumour cells re-entering the cell cycle can be treated over a longer period of time. However, due to the sustained drug release, the plasma levels of the charged drug are supposed to be lower than in conventional TACE, resulting in fewer systemic side effects. Furthermore, as the particles are available in different sizes (100–300µ, 300–500µ, 500–700µ and 700–900µ), effective arterial embolisation that results in local hypoxia can be achieved.
Figure 1a: Contrast-enhanced Computed Tomography Scan in the Arterial Phase Shows Multiple, Poorly Defined Tumour Nodules in the Right Liver Lobe
Figure 1b: Lower-level Contrast-enhanced Computed Tomography Scan Presents a Larger Tumour Nodule with Some Necrosis
References:
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- Vogl TJ, Mack MG, Straub R, et al., Interventionelle MR-gesteuerte laserinduzierte Thermotherapie bei onkologischen Fragestellunge, Radiologe, 1999;39:764–71.
- Llovet JM, Real MI, Montaña X, et al., Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial, Lancet, 2002;359:1734–9.
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- Clark HP, Carson WF, Kavanagh PV, et al., Staging and Current Treatment of Hepatocellular Carcinoma, Radiographics, 2005;25:S3–23.
- Konno T, Targeting cancer chemotherapeutic agents by use of lipiodol contrast medium, Cancer, 1990;66:1897–1903.
- Egawa H, Maki A, Mori K, et al., Effects of intra-arterial chemotherapy with a new lipophilic anticancer agent, estradiol-chlorambucil, dissolved in lipiodol on experimental liver tumor in rats, J Surg Oncol, 1990;44:109–14.
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- Sasaki Y, Imaoka S, Fujita M, et al., Regional Therapy in the Management of Intrahepatic Recurrence after Surgery for Hepatoma, Ann Surg, 1987;206:41–7.
- Lewis AL, Gonzalez MV, Lloyd AW, et al., DC bead: in vitro characterization of a drug-delivery decive for transarterial chemoembolization, J Vasc Interv Radiol, 2006;17:335–42.
- Fiorentini G, Aliberti C, Turrisi G, et al., Intra-arterial hepatic chemoembolization of liver metastases from colorectal cancer adopting irinotecan-eluting beads : results of a phase II clinical study, In Vivo, 2007;21:1085–91.
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- Malagari K, Alexopoulou E, Chatzimichail K, et al., Transcatheter chemoembolization in the treatment of HCC in patients not eligible for curative treatments: mid-term results of doxorubicin-loaded DC bead, Abdom Imaging, 2007; Epub ahead of print.
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