title: Degradable Starch Microspheres Transcatheter Arterial Chemoembolization (DSM-TACE) in Intrahepatic Cholangiocellular Carcinoma (ICC): Results from a National Multi-Center Study on Safety and Efficacy.
abstract: BACKGROUND The aim of this study was to evaluate the safety and efficacy of DSM (degradable starch microspheres) as an embolic agent in transarterial chemoembolization in the treatment of intrahepatic cholangiocellular carcinoma (ICC). MATERIAL AND METHODS This was a national, multi-center observational cohort study on the safety and efficacy of DSM-TACE using mitomycin, gemcitabine, cisplatin, doxorubicin, and carboplatin in palliative treatment of ICC. Recruitment period for the study was from January 2010 to June 2014. Primary endpoints were toxicity, safety, and response according to mRECIST criteria. RESULTS Twenty-five DSM-TACE procedures in cases of advanced ICC were performed in seven patients. Nausea and vomiting occurred as adverse event (AE) in eight out of 25 treatments (32%), with seven of eight events (87.5%) associated with the use of gemcitabine. In 11 out of 25 treatments (44%) moderate, transient epigastric pain was registered as an adverse event (AE) within 24 hours of DSM-TACE. One case (1/25) of severe AE (4%) with thrombocytopenia led to discontinuation of the DSM-TACE-treatment. A total of 25 DSM-TACE procedures with complete clinical and imaging follow-up over a two-year-period were analyzed: objective response (OR) was achieved in three of 25 treatments (12%) Disease control (DC) was achieved in 44% (11/25) of treatments; progress was registered in 4% (1/25). CONCLUSIONS The use of DSM as an embolic agent for TACE is safe in the treatment of ICC. A standardized anti-emetic medication should be established, especially when using gemcitabine. Further prospective studies need to be conducted to find the most suitable, standardized DSM-TACE treatment regime.
authors.affiliation: Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schicho
authors.affiliation: Department of Radiology, Minimal-invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn, Heilbronn, Germany.
authors.forename: Philippe L
authors.initials: PL
authors.lastname: Pereira
authors.affiliation: Department of Radiology and Nuclear Medicine, Raphaelsklinik Münster, Münster, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Pützler
authors.affiliation: Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Michalik
authors.affiliation: Department of Radiology, Vivantes Clinic Neukölln, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Albrecht
authors.affiliation: Department of Radiology, Evangelical Hospital Mülheim an der Ruhr, Mülheim an der Ruhr, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Nolte-Ernsting
authors.affiliation: Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stroszczynski
authors.affiliation: Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Wiggermann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001650:Bile Duct Neoplasms / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D016190:Carboplatin / Q000008:administration & dosage; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D018281:Cholangiocarcinoma / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D013213:Starch / Q000008:administration & dosage*; D000093542:Gemcitabine
chemical_list: C083286:degradable starch microspheres; D003841:Deoxycytidine; D016685:Mitomycin; D004317:Doxorubicin; D013213:Starch; D016190:Carboplatin; D002945:Cisplatin; D000093542:Gemcitabine