title: Transcatheter arterial chemoembolization with doxorubicin-eluting superabsorbent polymer microspheres in the treatment of hepatocellular carcinoma: midterm follow-up.
abstract: OBJECTIVE
  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).
  
  
  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.
authors.affiliation: Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Dekervel
authors.affiliation: Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium.
authors.forename: Hannah
authors.initials: H
authors.lastname: van Malenstein
authors.affiliation: Department of Radiology, University Hospitals Leuven, Herestraat 49.
authors.forename: Vincent
authors.initials: V
authors.lastname: Vandecaveye
authors.affiliation: Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium.
authors.forename: Frederik
authors.initials: F
authors.lastname: Nevens
authors.affiliation: Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium.
authors.forename: Jos
authors.initials: J
authors.lastname: van Pelt
authors.affiliation: Department of Radiology, University Hospitals Leuven, Herestraat 49.
authors.forename: Sam
authors.initials: S
authors.lastname: Heye
authors.affiliation: Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Laleman
authors.affiliation: Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium.
authors.forename: Werner
authors.initials: W
authors.lastname: Van Steenbergen
authors.affiliation: Department of Radiology, University Hospitals Leuven, Herestraat 49.
authors.forename: Johan
authors.initials: J
authors.lastname: Vaninbroukx
authors.affiliation: Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium.
authors.forename: Chris
authors.initials: C
authors.lastname: Verslype
authors.affiliation: Department of Radiology, University Hospitals Leuven, Herestraat 49. Electronic address: geert.maleux@uzleuven.be.
authors.forename: Geert
authors.initials: G
authors.lastname: Maleux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009367:Neoplasm Staging; D011108:Polymers / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000903:Antibiotics, Antineoplastic; D011108:Polymers; D004317:Doxorubicin
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