title: Degradable starch microspheres versus ethiodol and doxorubicin in transarterial chemoembolization of hepatocellular carcinoma.
abstract: OBJECTIVE
  To compare outcomes of transarterial chemoembolization with degradable starch microspheres (DSMs) and conventional transarterial chemoembolization with doxorubicin and Ethiodol in patients with unresectable intermediate-stage hepatocellular carcinoma (HCC).
  
  
  METHODS
  A total of 69 patients underwent 169 chemoembolization procedures with Ethiodol (n = 35) or DSMs (n = 34) as the embolic agent. The same chemotherapeutic agent was used for all patients (50 mg doxorubicin). The primary endpoint was patient survival, and secondary endpoints were local tumor response and incidence of therapy-associated complications with conventional or DSM chemoembolization. Tumor response was evaluated by consensus reading by two radiologists in accordance with modified Response Evaluation Criteria In Solid Tumors. Mean survival was calculated according to Kaplan-Meier analysis, and differences in survival curves were assessed by univariate log-rank test. The statistical significance of quantitative variables was determined by parameter-free Wilcoxon-Mann-Whitney U test.
  
  
  RESULTS
  The study groups were similar with regard to demographic data and disease stage. For the DSM chemoembolization group, the objective response rate (ie, complete or partial response) was 44.1%, and the rate of stable disease was 38.2%. The respective rates for the conventional chemoembolization group were 48.6% and 31.4%. Mean survival (P = .337) and complications did not significantly differ between groups (P = .907; P = 1.000).
  
  
  CONCLUSIONS
  DSM chemoembolization represents an alternative method of HCC treatment with a safety profile similar to that of conventional transarterial chemoembolization. Regarding local tumor response and overall survival, results of DSM chemoembolization were similar to those of conventional chemoembolization.
authors.affiliation: Department of Radiology, University Hospital Regensburg, Franz-Josef Strauss Allee 11, 93042 Regensburg, Germany. Electronic address: christoph.niessen@ukr.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Niessen
authors.affiliation: Department of Radiology, University Hospital Regensburg, Franz-Josef Strauss Allee 11, 93042 Regensburg, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Unterpaintner
authors.affiliation: Department of Radiology, University Hospital Regensburg, Franz-Josef Strauss Allee 11, 93042 Regensburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Goessmann
authors.affiliation: Department of Surgery, University Hospital Regensburg, Franz-Josef Strauss Allee 11, 93042 Regensburg, Germany.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schlitt
authors.affiliation: Department of Internal Medicine I, University Hospital Regensburg, Franz-Josef Strauss Allee 11, 93042 Regensburg, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Mueller-Schilling
authors.affiliation: Department of Radiology, University Hospital Regensburg, Franz-Josef Strauss Allee 11, 93042 Regensburg, Germany.
authors.forename: Walter A
authors.initials: WA
authors.lastname: Wohlgemuth
authors.affiliation: Department of Radiology, University Hospital Regensburg, Franz-Josef Strauss Allee 11, 93042 Regensburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stroszczynski
authors.affiliation: Department of Radiology, University Hospital Regensburg, Franz-Josef Strauss Allee 11, 93042 Regensburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Wiggermann
mesh_terms: D000368:Aged; 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; D004317:Doxorubicin / Q000008:administration & dosage* / Q000009:adverse effects; D004998:Ethiodized Oil / 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*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013213:Starch / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; C083286:degradable starch microspheres; C039040:ethiodized oil emulsion 13; D004998:Ethiodized Oil; D004317:Doxorubicin; D013213:Starch
keywords: ALT; AST; BCLC; Barcelona Clinic Liver Cancer; DSM; HCC; alanine aminotransferase; aspartate aminotransferase; degradable starch microsphere; hepatocellular carcinoma; mRECIST; modified Response Evaluation Criteria In Solid Tumors