title: Conventional versus doxorubicin-eluting bead transarterial chemoembolization for hepatocellular carcinoma.
abstract: OBJECTIVE
  To compare short- and long-term clinical outcomes after conventional transarterial chemoembolization and drug-eluting bead (DEB) transarterial chemoembolization in hepatocellular carcinoma (HCC).
  
  
  METHODS
  Patients with unresectable HCC unsuitable for ablative therapies were randomly assigned to undergo conventional or DEB chemoembolization. The primary endpoints of the study were safety, toxicity, and tumor response at 1 month. Secondary endpoints were number of repeated chemoembolization cycles, time to recurrence and local recurrence, time to radiologic progression, and survival.
  
  
  RESULTS
  In total, 67 patients (mean age, 70 y ± 7.7) were evaluated. Mean follow-up was 816 days ± 361. Two periprocedural major complications occurred (2.9%) that were treated by medical therapy without the need for other interventions. A significant increase in alanine aminotransferase levels 24 hours after treatment was reported, which was significantly greater after conventional chemoembolization (n = 34) than after DEB chemoembolization (n = 33; preprocedure, 60 IU ± 44 vs 74 IU ± 62, respectively; at 24 h, 216 IU ± 201 vs 101 IU ± 89, respectively; P = 0.007). No other differences were observed in liver toxicity between groups. At 1 month, complete and partial tumor response rates were 70.6% and 29.4%, respectively, in the conventional chemoembolization group and 51.5% and 48.5%, respectively, in the DEB chemoembolization group. No differences were observed between groups in time to recurrence and local recurrence, radiologic progression, and survival.
  
  
  CONCLUSIONS
  Conventional chemoembolization and DEB chemoembolization have a limited impact on liver function on short- and long-term follow-up and are associated with favorable clinical outcomes.
authors.affiliation: Department of Gastroenterology, Pisa University Hospital, Pisa, Italy. r.sacco@ao-pisa.toscana.it
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Sacco
authors.forename: Irene
authors.initials: I
authors.lastname: Bargellini
authors.forename: Marco
authors.initials: M
authors.lastname: Bertini
authors.forename: Elena
authors.initials: E
authors.lastname: Bozzi
authors.forename: Antonio
authors.initials: A
authors.lastname: Romano
authors.forename: Pasquale
authors.initials: P
authors.lastname: Petruzzi
authors.forename: Emanuele
authors.initials: E
authors.lastname: Tumino
authors.forename: Barbara
authors.initials: B
authors.lastname: Ginanni
authors.forename: Graziana
authors.initials: G
authors.lastname: Federici
authors.forename: Roberto
authors.initials: R
authors.lastname: Cioni
authors.forename: Salvatore
authors.initials: S
authors.lastname: Metrangolo
authors.forename: Michele
authors.initials: M
authors.lastname: Bertoni
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bresci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Parisi
authors.forename: Emanuele
authors.initials: E
authors.lastname: Altomare
authors.forename: Alfonso
authors.initials: A
authors.lastname: Capria
authors.forename: Carlo
authors.initials: C
authors.lastname: Bartolozzi
mesh_terms: D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage* / Q000009:adverse effects; D004337:Drug Carriers; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000903:Antibiotics, Antineoplastic; D004337:Drug Carriers; D004317:Doxorubicin