Optimal technique and response of doxorubicin beads in hepatocellular cancer: bead size and dose
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: It has been shown that the drug-eluting beads loaded with doxorubicin (DEBDOX) are effective for the treatment of hepatocellular carcinoma (HCC). However, the optimal safety and efficacy still remain to be established by using various bead sizes, doxorubicin doses, and the degree of stasis.The aim of this study was to determine the optimal safety and efficacy of DEBDOX in the treatment of HCC. Methods: Analysis of a 503 patient prospective, multicenter, multinational Bead Registry Database from 2007 to 2010 identified 206 patients who had been treated for HCC with DEBDOX. Primary endpoints were to compare safety, tolerance, response rates, and overall survival based on bead size (100-300, 300-500, 500-700, and 700-900 μm), number of vials, doxorubicin dose, and degree of stasis. Results: In total, 206 patients underwent 343 treatments. The use of all four bead sizes was similar based on Child-Pugh class and Okuda stage, with a significantly higher use (50%) of beads of size 100-300 μm in patients with portal vein thrombosis (P=0.05). Significant differences were seen for the number of median treatments, median doxorubicin dose, lobar infusion), and degree of complete stasis. The rate of adverse events was higher for larger beads than for smaller beads (28% vs. 16%; P=0.02). Conclusions: Bead size and dose may vary according to disease distribution. Smaller beads offer the opportunity for repeated treatments, a larger cumulative dose delivery, a lesser degree of complete stasis, and fewer adverse events.
Abstract
Background/Aims: It has been shown that the drug-eluting beads loaded with doxorubicin (DEBDOX) are effective for the treatment of hepatocellular carcinoma (HCC). However, the optimal safety and efficacy still remain to be established by using various bead sizes, doxorubicin doses, and the degree of stasis.The aim of this study was to determine the optimal safety and efficacy of DEBDOX in the treatment of HCC. Methods: Analysis of a 503 patient prospective, multicenter, multinational Bead Registry Database from 2007 to 2010 identified 206 patients who had been treated for HCC with DEBDOX. Primary endpoints were to compare safety, tolerance, response rates, and overall survival based on bead size (100-300, 300-500, 500-700, and 700-900 μm), number of vials, doxorubicin dose, and degree of stasis. Results: In total, 206 patients underwent 343 treatments. The use of all four bead sizes was similar based on Child-Pugh class and Okuda stage, with a significantly higher use (50%) of beads of size 100-300 μm in patients with portal vein thrombosis (P=0.05). Significant differences were seen for the number of median treatments, median doxorubicin dose, lobar infusion), and degree of complete stasis. The rate of adverse events was higher for larger beads than for smaller beads (28% vs. 16%; P=0.02). Conclusions: Bead size and dose may vary according to disease distribution. Smaller beads offer the opportunity for repeated treatments, a larger cumulative dose delivery, a lesser degree of complete stasis, and fewer adverse events.
참고문헌 (18)
- Lammer J, "Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study", Cardiovasc Intervent Radiol, 33, pp.41~52 (2010)
- Poon RT, "A phase I", II trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drug-eluting bead, 2007, pp.5, 1100~1108
- Malagari K, "Prospective randomized comparison of chemoembolization with doxorubicin-eluting beads and bland embolization with BeadBlock for hepatocellular carcinoma", Cardiovasc Intervent Radiol, 33, pp.541~551 (2010)
- Varela M, "Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics", J Hepatol, 46, pp.474~481 (2007)
- Reyes DK, "Single-center phase II trial of transarterial chemoembolization with drug-eluting beads for patients with unresectable hepatocellular carcinoma: initial experience in the United States", Cancer J, 15, pp.526~532 (2009)
- Maluccio M, "Comparison of survival rates after bland arterial embolization and ablation versus surgical resection for treating solitary hepatocellular carcinoma up to 7 cm", J Vasc Interv Radiol, 16, pp.955~961 (2005)
- Maluccio MA, "Transcatheter arterial embolization with only particles for the treatment of unresectable hepatocellular carcinoma", J Vasc Interv Radiol, 19, pp.862~869 (2008)
- Brown KT, "Particle embolization for hepatocellular carcinoma", J Vasc Interv Radiol, 9, pp.822~828 (1998)
- Kawai S, "Prospective and randomized clinical trial for the treatment of hepatocellular carcinoma-a comparison of lipiodol-transcatheter arterial embolization with and without adriamycin (first cooperative study). The Cooperative Study Group for Liver Cancer Treatment of Japan", Cancer Chemother Pharmacol, 31, pp.1~6 (1992)
- Varela M, "Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics", J Hepatol, 46, pp.474~481 (2007)
- Poon RT, "A phase I", II trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drug-eluting bead, 2007, pp.5, 1100~1108
- Lammer J, "Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study", Cardiovasc Intervent Radiol, 33, pp.41~52 (2010)
- Malagari K, "Prospective randomized comparison of chemoembolization with doxorubicin-eluting beads and bland embolization with BeadBlock for hepatocellular carcinoma", Cardiovasc Intervent Radiol, 33, pp.541~551 (2010)
- Sergio A, "Transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC): the role of angiogenesis and invasiveness", Am J Gastroenterol, 103, pp.914~921 (2008)
- Mamori S, "Survivin expression in early hepatocellular carcinoma and post-treatment with anti-cancer drug under hypoxic culture condition", World J Gastroenterol, 13, pp.5306~5311 (2007)
- Mita AC, "Survivin: key regulator of mitosis and apoptosis and novel target for cancer therapeutics", Clin Cancer Res, 14, pp.5000~5005 (2008)
- Leung DA, "Determinants of postembolization syndrome after hepatic chemoembolization", J Vasc Interv Radiol, 12, pp.321~326 (2001)
- Patel NH, "Hepatic artery embolization: factors predisposing to postembolization pain and nausea", J Vasc Interv Radiol, 11, pp.453~460 (2000)