title: Survival of patients with intermediate stage hepatocellular carcinoma treated with superselective transarterial chemoembolization using doxorubicin-loaded DC Bead under cone-beam computed tomography control.
abstract: BACKGROUND
  The purpose of this retrospective study was to evaluate treatment response, adverse events and survival rates of patients with intermediate stage HCC treated with superselective doxorubicin-loaded DC Bead transarterial chemoembolization (DEBDOX) under cone beam computed tomography (CBCT) control.
  
  
  METHODS
  Between October 2010 and June 2012, 35 consecutive patients with intermediate stage HCC (32 male, 3 female; average age, 67.5 ± 7.8 years; 22 patients Child-Pugh class A, 8 class B, 5 without cirrhosis) were treated with DEBDOX TACE. Portal vein thrombosis was observed in 6 (17.1%) patients. DEBDOX TACE was performed by superselective catheterization of feeding vessels followed by embolization with 100-300 μm microspheres loaded with 50-100 mg of doxorubicin. In all cases, CBCT was used during chemoembolization. Tumor response rates were defined according to mRECIST criteria.
  
  
  RESULTS
  Overall, 120 procedures were performed (mean, 3.2 per patients). We treated 97 lesions with an average diameter of 4.9 ± 1.9 cm. There were 32 minor and 2 (1.6%) major complications (one liver abscess and one cerebrovascular insult). After a mean follow-up of 27.7 ± 10.5 months, 94.3% of patients achieved an objective response to treatment (42.4% complete response and 57.6% partial response). Mean time to progression was 10.9 ± 5.3 months. Mean overall survival was 33.9 months (95% CI; 28.9 - 38.9 months), with 1- and 2- year survival of 97.1% and 65.7%, respectively.
  
  
  CONCLUSIONS
  Superselective DEBDOX TACE performed under CBCT control is a safe and effective method with high rates of tumor response and overall survival.
authors.affiliation: Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Peter
authors.initials: P
authors.lastname: Popovic
authors.affiliation: Gastroenterology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Borut
authors.initials: B
authors.lastname: Stabuc
authors.affiliation: Gastroenterology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Rado
authors.initials: R
authors.lastname: Jansa
authors.affiliation: Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Manca
authors.initials: M
authors.lastname: Garbajs
keywords: chemoembolization; cone-beam computed tomography; doxorubicin; drug eluting bead; hepatocellular carcinoma