title: Survival, efficacy, and safety of small versus large doxorubicin drug-eluting beads TACE chemoembolization in patients with unresectable HCC.
abstract: OBJECTIVE
  The purpose of this study was to investigate the overall survival, efficacy, and safety of small (100-300 µm) versus large (300-500 and 500-700 µm) doxorubicin drug-eluting beads transarterial chemoembolization (DEB TACE) in patients with unresectable hepatocellular carcinoma (HCC).
  
  
  METHODS
  Ninety-four consecutive patients with unresectable HCC who underwent 269 DEB TACE procedures in 48 months were studied. DEB TACE procedures were performed using different DEB sizes: 100-300 µm (Group A, 59 patients) and with mixed 300-500 and 500-700 µm DEB (Group B, 35 patients). Survival rates were compared between the groups.
  
  
  RESULTS
  The overall median survival in groups A and B were 15.1 and 11.1 months, respectively (p=0.005). Both groups were similar in demographics, tumor burden, and differential staging (p>0.5). Substratification of overall survival according to Child-Pugh class and Okuda, Cancer of the Liver Italian Program (CLIP), and Barcelona Clinic Liver Cancer (BCLC) staging were significantly higher in group A than in group B (p<0.05). Common terminology criteria for adverse events (CTCAE) grade III adverse events and 30-day mortality were significantly lower in group A than in group B (6.8% vs 20%; p=0.04, and 0% vs 14.3%; p=0.001, respectively). The particle size, Child-Pugh class, and serum α-fetoprotein level were significant prognostic indicators of survival on multivariate analysis.
  
  
  CONCLUSIONS
  TACE with 100-300 µm sized DEB is associated with significantly higher survival rate and lower complications than TACE with 300-500 and 500-700 µm sized DEB.
authors.affiliation: 1 Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Hasmukh J
authors.initials: HJ
authors.lastname: Prajapati
authors.forename: Minzhi
authors.initials: M
authors.lastname: Xing
authors.forename: James R
authors.initials: JR
authors.lastname: Spivey
authors.forename: Steven I
authors.initials: SI
authors.lastname: Hanish
authors.forename: Bassel F
authors.initials: BF
authors.lastname: El-Rayes
authors.forename: John S
authors.initials: JS
authors.lastname: Kauh
authors.forename: Zhengjia
authors.initials: Z
authors.lastname: Chen
authors.forename: Hyun S
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000401:mortality*; D015897:Comorbidity; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000737:chemistry; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000401:mortality*; D010146:Pain / Q000401:mortality; D010316:Particle Size; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D003692:Delayed-Action Preparations; D004317:Doxorubicin
keywords: doxorubicin drug-eluting beads transarterial chemoembolization (DEB TACE); small versus large DEB TACE; unresectable hepatocellular carcinoma (HCC)