title: Transcatheter chemoembolization in the treatment of HCC in patients not eligible for curative treatments: midterm results of doxorubicin-loaded DC bead.
abstract: OBJECTIVE
  To examine the results of segmental transcatheter arterial chemoembolization with doxorubicin-loaded DC Bead in the treatment of hepatocellular carcinoma (HCC) in non-surgical candidates.
  
  
  METHODS
  Seventy-one patients (60% men; 11% women; mean age 63; range 46-71 years) with documented HCC of 3-10 cm in diameter (mean 6.2) were enrolled prospectively in the study. All patients had cirrhosis-related HCC that was developed on an underlying controlled hepatitis infection. Only patients with compensated cirrhosis--Child A or B--were included in this study.
  
  
  RESULTS
  Overall complete response (CR) according to EASL on an intention to treat basis was seen in 11 patients who developed complete necrosis (15.5%). Objective response (OR) ranged from 66.2% to 85.5% across the four treatments. Survival at 12 months was 97.05%. Sustained CR was observed in 11 (16.1%), and OR in 49 (72%). Sustained partial response was seen in 49 patients (72.05%). Survival at 18 months was 94.1%. At 24 months follow-up survival was 91.1%. Sustained OR was seen in 45 patients (66.2%) while sustained CR was 16.1% (11/68). At 30 months survival was 88.2%. One patient with CR developed multifocal HCC in areas that most likely were not embolized during the previous embolization sessions. In this patient recurrence-free survival was 28 months. Alpha Fetroprotein levels decreased significantly in measurements 1 month post each procedure (p < 0.001). Bilirubin, gamma-GT, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase (ALP) showed only transient increases observed during the study period. Severe procedure-related complications were seen in 4.2% (cholecystitis: n = 1; liver abscess: n = 1; pleural effusion: n = 1). Post Embolization Syndrome (PES) was observed in all patients.
  
  
  CONCLUSIONS
  Transcatheter arterial chemoembolization with DC Bead is an effective and safe procedure in the treatment of HCC patients not eligible for curative treatments with high rates of response and high rates of mid term survival.
authors.affiliation: Department of Radiology, University of Athens, Athens, Greece. kmalag@acn.gr
authors.forename: Katerina
authors.initials: K
authors.lastname: Malagari
authors.forename: Efthimia
authors.initials: E
authors.lastname: Alexopoulou
authors.forename: Katerina
authors.initials: K
authors.lastname: Chatzimichail
authors.forename: Brenda
authors.initials: B
authors.lastname: Hall
authors.forename: John
authors.initials: J
authors.lastname: Koskinas
authors.forename: Samantha
authors.initials: S
authors.lastname: Ryan
authors.forename: Eva
authors.initials: E
authors.lastname: Gallardo
authors.forename: Alexis
authors.initials: A
authors.lastname: Kelekis
authors.forename: Athanassios
authors.initials: A
authors.lastname: Gouliamos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kelekis
mesh_terms: D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D004317:Doxorubicin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000628:therapy; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin