Repeated Transarterial Chemoembolization with Degradable Starch Microspheres (DSMs-TACE) of Unresectable Hepatocellular Carcinoma: A Prospective Pilot Study
Autor: | Mario Angelico, Stefano Merolla, Simona Francioso, Fabrizio Chegai, Giuseppe Tisone, Antonio Orlacchio, Serena Monti, Lorenzo Di Cesare Mannelli |
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Rok vydání: | 2018 |
Předmět: |
medicine.medical_specialty
Treatment response Hepatocellular carcinoma HCC cirrhotic patients degradable starch microspheres locoregional therapies recurrence-free survival transcatheter arterial chemoembolization Tumor response Settore MED/05 Gastroenterology Article 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Radiology Nuclear Medicine and imaging In patient Transcatheter arterial chemoembolization Degradable starch microspheres business.industry medicine.disease Settore MED/18 Discontinuation 030220 oncology & carcinogenesis Liver function business |
Zdroj: | Current Medical Imaging Reviews |
ISSN: | 1573-4056 |
DOI: | 10.2174/1573405613666170616123657 |
Popis: | Objective: The aims of this study were to: a) evaluate tumor response rates using modified-Response-evaluation-criteria-in-solid-tumors (mRecist) criteria, b) evaluate safety of Degradable Starch Microspheres Trans-arterial-chemo-embolization (DSMs-TACE) for unresectable hepatocellular-carcinoma (HCC) treatment. Materials and Methods: We prospectively enrolled 24 HCC cirrhotic patients (21/3 M/F, mean age 66.3 years) to be treated with repeated DSMs-TACE procedures, performed at 4-6 week intervals on the basis of tumor response and patients tolerance. Clinical and biochemical evaluations were performed before and after each procedure. Treatment response was also assessed by Computed-tomography (CT) or Magnetic-resonance-imaging (MRI)-scan 4-6 weeks following each procedure. Results: In our experience, DSMs-TACE was both safe and effective. A total of 53 DSMs-TACE procedures were performed (2.2 per patient). No procedure-related death was observed. Complete Response (CR) was observed in 5/24 (20.8%), 4/17 (23.5%) and 5/12 (41.6%) patients after the first, second and third procedure, respectively. At the end of each treatment, all patients experienced at least a partial response. At the end of the repeated procedures, no differences between mono- or bi-lobar disease were observed in patients with CR (64.2% vs 50%; p=ns). In most cases, treatment discontinuation was due to worsening liver function. Conclusion: DSMs-TACE is a valid, well-tolerated alternative treatment to Lipiodol-TACE or DEB-TACE, as it has demonstrated to achieve a relatively high percentage of complete tumor necrosis. CR rates were similar between patients with mono- or bi-lobar disease indicating the possibility of carrying-out repeated procedure in a safe and effective way in both types of patients. |
Databáze: | OpenAIRE |
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