Safety and Efficacy of Drug-eluting Bead Chemoembolization for Hepatocellular Carcinoma: Comparison of Small-versus Medium-size Particles

Authors: Siddharth A. Padia, MD, Giri Shivaram, MD, Sarah Bastawrous, DO, Puneet Bhargava, MD, Nghia J. Vo, MD, Sandeep Vaidya, MD, Karim Valji, MD, William P. Harris, MD, Daniel S. Hippe, MS, Matthew J. Kogut, MD


Purpose
To compare safety and imaging response with 100–300 μm and 300–500 μm doxorubicin drug-eluting bead (DEBs) to determine optimal particle size for chemoembolization of hepatocellular carcinoma (HCC).


Materials and Methods

DEB chemoembolization using 100–300 μm (n = 39) or 300–500 μm (n = 22) LC beads loaded with 50 mg of doxorubicin was performed in 61 patients with HCC. Patient age, sex, etiology of liver disease, degree of underlying liver disease, tumor burden, and performance status were similar between the groups. All treatments were performed in a single session and represented the patient’s first treatment. Toxicities and imaging response in a single index tumor were analyzed using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) criteria.


Results

There was a significantly lower incidence of postembolization syndrome and fatigue after treatment in the 100–300 μm group (8% and 36%) versus the 300–500 μm group (40% and 70%) (100–300 μm group, P = .011; 300–500 μm group, P = .025). Mean change in tumor size was similar between the two groups based on WHO and EASL criteria and similar rates of objective response, but there was a trend toward a higher incidence of EASL complete response with 100–300 μm beads versus 300–500 μm beads (59% vs 36%; P = .114).


Conclusions

In DEB chemoembolization for treatment of HCC, 100–300 μm doxorubicin DEBs are favored over 300–500 μm doxorubicin DEBs because of lower rates of toxicity after treatment and a trend toward more complete imaging response at initial follow-up.