title: Optimal technique and response of doxorubicin beads in hepatocellular cancer: bead size and dose.
abstract: OBJECTIVE
  It has been shown that the drug-eluting beads loaded with doxorubicin (DEBDOX) are effective for the treatment of hepatocellular carcinoma (HCC). However, the optimal safety and efficacy still remain to be established by using various bead sizes, doxorubicin doses, and the degree of stasis.The aim of this study was to determine the optimal safety and efficacy of DEBDOX in the treatment of HCC.
  
  
  METHODS
  Analysis of a 503-patient prospective, multicenter, multinational Bead Registry Database from 2007 to 2010 identified 206 patients who had been treated for HCC with DEBDOX. Primary endpoints were to compare safety, tolerance, response rates, and overall survival based on bead size (100-300, 300-500, 500-700, and 700-900 μm), number of vials, doxorubicin dose, and degree of stasis.
  
  
  RESULTS
  In total, 206 patients underwent 343 treatments. The use of all four bead sizes was similar based on Child-Pugh class and Okuda stage, with a significantly higher use (50%) of beads of size 100-300 μm in patients with portal vein thrombosis (P=0.05). Significant differences were seen for the number of median treatments, median doxorubicin dose, lobar infusion), and degree of complete stasis. The rate of adverse events was higher for larger beads than for smaller beads (28% vs. 16%; P=0.02).
  
  
  CONCLUSIONS
  Bead size and dose may vary according to disease distribution. Smaller beads offer the opportunity for repeated treatments, a larger cumulative dose delivery, a lesser degree of complete stasis, and fewer adverse events.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville College of Medicine, Louisville, KY 40202, USA. Robert.Martin@louisville.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Martin
authors.forename: Javier
authors.initials: J
authors.lastname: Irurzun
authors.forename: Jordi
authors.initials: J
authors.lastname: Munchart
authors.forename: Igor
authors.initials: I
authors.lastname: Trofimov
authors.forename: Alexander
authors.initials: A
authors.lastname: Scupchenko
authors.forename: Cliff
authors.initials: C
authors.lastname: Tatum
authors.forename: Govindarajan
authors.initials: G
authors.lastname: Narayanan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage* / Q000009:adverse effects; D004337:Drug Carriers / Q000737:chemistry*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010316:Particle Size; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D000903:Antibiotics, Antineoplastic; D004337:Drug Carriers; D004317:Doxorubicin