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Prospective Randomized Comparison of Chemoembolization with Doxorubicin-Eluting Beads and Bland Embolization with BeadBlock for Hepatocellular Carcinoma

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Abstract

The purpose of this study was to evaluate the added role of a chemotherapeutic in transarterial chemoembolization (TACE) of intermediate-stage hepatocellular carcinoma (HCC). The issue is of major importance since, as suggested by recent evidence, hypoxia or incomplete devascularization of the tumor is a potent stimulator of angiogenesis, and there are not many papers supplying level one evidence confirming the value of a chemotherapeutic. The hypothesis was that since drug-eluting bead (DEB)-TACE is standardized and reproducible, a comparison with bland TACE can readily reveal the potential value of the chemotherapeutic. Two groups were randomized in this prospective study: group A (n = 41) was treated with doxorubicin DEB-TACE, and group B (n = 43) with bland embolization. Patients were randomized for tumor diameter. Patients were embolized at set time intervals (2 months), with a maximum of three embolizations. Tumor response was evaluated using the EASL criteria and α-fetoprotein levels. At 6 months a complete response was seen in 11 patients (26.8%) in the DEB-TACE group and in 6 patients (14%) in the bland embolization group; a partial response was achieved in 19 patients (46.3%) and 18 (41.9%) patients in the DEB-TACE and bland embolization groups, respectively. Recurrences at 9 and 12 months were higher for bland embolization (78.3% vs. 45.7%) at 12 months. Time to progression (TTP) was longer for the DEB-TACE group (42.4 ± 9.5 and 36.2 ± 9.0 weeks), at a statistically significant level (p = 0.008). In conclusion, DEB-TACE presents a better local response, fewer recurrences, and a longer TTP than bland embolization with BeadBlock. However, survival benefit and bland embolization with smaller particles must be addressed in future papers to better assess the clinical value.

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Authors and Affiliations

  1. Imaging and Research Unit, Second Department of Radiology, Evgenidion Hospital, University of Athens, Athens, Greece

    Katerina Malagari & Alexis Kelekis

  2. Imaging and Research Unit, Evgenidion Hospital, University of Athens, Athens, Greece

    Mary Pomoni, Hippokratis Moschouris & Dimitrios Kelekis

  3. Lausanne, Switzerland

    Anastasia Pomoni

  4. Department of Internal Medicine, University of Athens, Athens, Greece

    Spyros Dourakis

  5. Second Department of Radiology, University of Athens, Athens, Greece

    Themis Spyridopoulos & Emmanouil Emmanouil

  6. Tzanion Hospital, Athens, Greece

    Spyros Rizos

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  1. Katerina Malagari
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  2. Mary Pomoni
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Correspondence to Katerina Malagari.

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Malagari, K., Pomoni, M., Kelekis, A. et al. Prospective Randomized Comparison of Chemoembolization with Doxorubicin-Eluting Beads and Bland Embolization with BeadBlock for Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 33, 541–551 (2010). https://doi.org/10.1007/s00270-009-9750-0

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