Korean J Radiol.  2019 Jan;20(1):34-49. 10.3348/kjr.2018.0088.

Update on Transarterial Chemoembolization with Drug-Eluting Microspheres for Hepatocellular Carcinoma

• Nouri YM
• Kim JH
• Yoon HK
• Ko HK
• Shin JH
• Gwon DI

• KMID: 2429918
• DOI: http://doi.org/10.3348/kjr.2018.0088

Abstract

Conventional transcatheter arterial chemoembolization (c-TACE) is a widely used first-line palliative treatment for patients with unresectable hepatocellular carcinoma (HCC). Despite the effectiveness of c-TACE, to date, technique and procedure scheduling has not yet been standardized. Drug-eluting microspheres (DEMs) were therefore introduced to ensure more sustained and tumor-selective drug delivery for permanent embolization. These DEMs can load various drugs and release them in a sustained manner over a prolonged period. This approach ensures the delivery of high concentrations of chemotherapeutic agents to tumors, without increasing systemic concentrations, and promote tumor ischemia and necrosis. This review summarizes the recent advances in the use of DEM-TACE to treat HCC.

Keyword

DEB-TACE; DEM-TACE; Chemoembolization; HCC; Liver; Review

MeSH Terms

Carcinoma, Hepatocellular*
Humans
Ischemia
Liver
Microspheres*
Necrosis
Palliative Care

Figure

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  Fig. 1 DC Bead® (BTG).A. Bottle of DC Bead® (100–300 µm) before loading. B. Bottle of DC Bead® (100–300 µm) loaded with doxorubicin.

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  Fig. 2 Technique of HepaSphere™ (Merit Medical) TACE.A. Hepatic angiography showing single tumor blush (arrow). B, C. Cone-beam CT angiography precisely delineating single tumor feeder (yellow line). D. HepaSphere™ (30–60 µm) loaded with doxorubicin is slowly injected. CT = computed tomography, TACE = transcatheter arterial chemoembolization

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  Fig. 3 Technique of DC Bead® (BTG) TACE.A. Celiac angiography showing single small tumor blush and tumor feeder (arrow). B. After selection of tumor feeder using microcatheter, DC Bead® (100–300 µm) loaded with doxorubicin/nonionic contrast suspension are slowly injected, usually over 1 minute for 1 mL injection.

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  Fig. 4 70-year-old woman with single, intermediate-size HCC (4.3 cm in diameter).A. Axial contrast-enhanced CT in arterial phase showing 4.3 cm HCC (arrow) in segment 6. B. Hepatic angiography showing single small tumor blush (arrow). C. Axial contrast-enhanced CT image one month after HepaSphere™ (Merit Medical) TACE demonstrating complete response. HCC = hepatocellular carcinoma

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  Fig. 5 DC Bead® (BTG) TACE as bridge to liver transplantation.A. Axial contrast-enhanced CT image in arterial phase showing multiple HCCs (beyond Milan criteria) (arrows) in caudate lobe. B, C. Arteriography obtained at caudate branch (arrowhead) showing tumor blushes (arrows) in caudate lobe. D. Axial contrast-enhanced CT image one month after DC Bead® TACE showing complete response.

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  Fig. 6 Use of 30–60-µm HepaSphere™ (Merit Medical) TACE for Multinodular HCCs.A. Axial contrast-enhanced CT image in arterial phase showing multiple HCCs (arrows) in right lobe of liver. B, C. Axial contrast-enhanced CT images in arterial phase after 1 and 6 months, respectively, showing complete response with no recurrence.

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  Fig. 7 Use of 70–150-µm DC Bead® (BTG) TACE for Multinodular HCCs.A, B. Axial contrast-enhanced CT images in arterial phase showing multiple HCCs (arrows) in right lobe of liver. C, D. Axial contrast-enhanced CT images in arterial phase after 1 month showing only partial response.

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