Transcatheter arterial chemoembolization with doxorubicin-eluting superabsorbent polymer microspheres in the treatment of hepatocellular carcinoma: midterm follow-up

J Vasc Interv Radiol. 2014 Feb;25(2):248-55.e1. doi: 10.1016/j.jvir.2013.10.017. Epub 2013 Dec 2.

Abstract

Purpose: To investigate prospectively the safety, tolerability, and efficacy of transarterial chemoembolization using superabsorbent polymer (SAP) microspheres loaded with doxorubicin for the treatment of hepatocellular carcinoma (HCC).

Materials and methods: During the years 2006-2011, 64 patients underwent 144 transarterial chemoembolization with SAP microspheres procedures. Most of the patients were staged as Barcelona Clinic Liver Cancer class B (65%). The most frequent underlying liver diseases were hepatitis C (35%) and alcoholic liver disease (28%) resulting in Child-Pugh A (73.4%) or Child-Pugh B (17%) liver cirrhosis. Tumor response was assessed using modified Response Evaluation Criteria in Solid Tumors with magnetic resonance (MR) imaging performed 4-6 weeks after each procedure.

Results: Serious adverse events (n = 9) were ischemic or infectious in nature. Transarterial chemoembolization with SAP microspheres resulted in objective response rates of 67.5%, 44.5%, and 25% after first, second, and third sessions. There were 16 patients (25%) who underwent orthotopic liver transplantation after transarterial chemoembolization with SAP microspheres, of whom 2 experienced recurrent disease. During a median follow-up time of 14 months (range, 2-55 mo), 26 patients (40.5%) died. Median overall and transplant-free survivals were 20.5 months (95% confidence interval, 13.2-27.7) and 18 months (95% confidence interval, 14.2-21.8), respectively.

Conclusions: Transarterial chemoembolization with SAP microspheres has an excellent safety profile in cirrhotic patients, even in the presence of advanced liver disease (Child-Pugh B) or advanced stages of HCC. This treatment produced meaningful tumor response rates as assessed by MR imaging.

Keywords: BCLC; Barcelona Clinic Liver Class; HCC; OLT; SAE; SAP; hepatocellular carcinoma; mRECIST; modified Response Evaluation Criteria In Solid Tumors; orthotopic liver transplantation; serious adverse event; superabsorbent polymer.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antibiotics, Antineoplastic / administration & dosage*
  • Antibiotics, Antineoplastic / adverse effects
  • Carcinoma, Hepatocellular / blood supply
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / pathology
  • Carcinoma, Hepatocellular / therapy*
  • Chemoembolization, Therapeutic / adverse effects
  • Chemoembolization, Therapeutic / methods*
  • Chemoembolization, Therapeutic / mortality
  • Disease-Free Survival
  • Doxorubicin / administration & dosage*
  • Doxorubicin / adverse effects
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Liver Neoplasms / blood supply
  • Liver Neoplasms / mortality
  • Liver Neoplasms / pathology
  • Liver Neoplasms / therapy*
  • Liver Transplantation
  • Magnetic Resonance Imaging
  • Male
  • Microspheres
  • Middle Aged
  • Neoplasm Staging
  • Polymers / administration & dosage*
  • Polymers / adverse effects
  • Prospective Studies
  • Time Factors
  • Treatment Outcome
  • Tumor Burden

Substances

  • Antibiotics, Antineoplastic
  • Polymers
  • Doxorubicin