title: Segmental and lobar administration of drug-eluting beads delivering irinotecan leads to tumour destruction: a case-control series.
abstract: BACKGROUND
  Irinotecan-loaded drug-eluting beads represent a novel drug delivery method that allows for the locoregional delivery of irinotecan to colorectal liver metastases (CRLM). The method has shown impressive response rates. However, the pathological response to this treatment has not previously been demonstrated.
  
  
  METHODS
  Patients with easily resectable CRLM were treated with drug-eluting beads delivering irinotecan (DEBIRI) 4 weeks prior to resection. Pathological tumour response was graded using a validated system. The intraoperative detection of previously unidentified disease allowed for the assessment of pathological responses directly attributable to bead treatment.
  
  
  RESULTS
  In Patient 1, segmental embolization of the target lesion in segment VIII resulted in 100% necrosis (0% viability). An untreated lesion in segment IV was found to be 30% viable. In Patient 2, subsegmental embolization of the target lesion in segment VI resulted in 60% necrosis and 40% fibrosis (0% viability). An untreated lesion in segment VI remained 60% viable. In Patient 3, lobar embolization of the target lesion in segment II resulted in 0% viability. Two further lesions within the treated hemiliver, both with 0% viability, and one lesion in the untreated hemiliver with 45% viability were discovered at laparotomy.
  
  
  CONCLUSIONS
  This series demonstrates the effectiveness of DEBIRI in the treatment of CRLM. High rates of tumour destruction are possible, even with the proximal lobar administration of DEBIRI. Lobar administration appears to be an appropriate method of delivery for integration into future therapeutic regimens.
authors.affiliation: School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, UK. robjones@liv.ac.uk
authors.forename: Robert P
authors.initials: RP
authors.lastname: Jones
authors.forename: Declan
authors.initials: D
authors.lastname: Dunne
authors.forename: Paul
authors.initials: P
authors.lastname: Sutton
authors.forename: Hassan Z
authors.initials: HZ
authors.lastname: Malik
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Fenwick
authors.forename: Monica
authors.initials: M
authors.lastname: Terlizzo
authors.forename: Elizabeth
authors.initials: E
authors.lastname: O'Grady
authors.forename: Claus
authors.initials: C
authors.lastname: Koelblinger
authors.forename: Stefan
authors.initials: S
authors.lastname: Stättner
authors.forename: Stefan
authors.initials: S
authors.lastname: Stremitzer
authors.forename: Thomas
authors.initials: T
authors.lastname: Gruenberger
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Poston
mesh_terms: D000328:Adult; D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016461:Chemoembolization, Therapeutic; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D004337:Drug Carriers; D005060:Europe; D006498:Hepatectomy; D006801:Humans; D000077146:Irinotecan; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D004337:Drug Carriers; D000077146:Irinotecan; D002166:Camptothecin