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∎ FEATURED ABSTRACT Influence of bead size on tumor response rate after drug-eluting bead transcatheter arterial chemoembolization in hepatocellular carcinoma

      Purpose

      To assess the influence of bead size on hepatocellular carcinoma (HCC) response rates after drug-eluting bead (DEB) transcatheter arterial chemoembolization (TACE).

      Materials and Methods

      BCLC Stage B patients with HCC underwent two sequential TACE with 100 mg Doxorubicin loaded on 2 vials of DEB (LC Bead™). 74 patients were treated with large beads (LB) 300-500μm and 500-700μm in diameter, 33 with medium beads (MB) 100-300μm and 300-500μm, and 36 with small beads (SB) 75-150μm and 100-300μm. Selective TACE was performed until stasis was achieved in the subsegmental arteries. Patients were evaluated with imaging in 3-month intervals and followed for 12 months. Follow-up imaging was analyzed using mRECIST and volumetric lesion assessment. Group comparison was performed using extended Fisher exact test with significant p value of 0.05. In the presence of progressive disease, re-treatment was performed until untreatable progression was diagnosed. Incompletely treated patients and ones lost follow-up were excluded.

      Results

      At 3 months, complete response rates for LB, MB and SB groups were 25/74 (34%), 24/33 (73%) and 33/36 (92%), respectively (p < 0.01). At 12 months, complete response rates for LB, MB and SB groups were 20/74 (27%), 19/33 (63%), 21/36 (72%), respectively (p = 0.06). Progressive disease at 12 months was noted in 9 (21%) of LB group, 5 (17%) in MB group and 4 (14%) in SB group. Disease progression was mainly due to new lesions in untreated areas. SB group re-treatment was technically easier due to minimal initial impact on larger intra-hepatic artery branches.

      Conclusion

      TACE using smaller DEB is associated with better initial tumor response at 3 and 6 months. Lack of difference in response between groups at 9 and 12 months is primarily related to disease progression in untreated areas. Elective re-treatment is technically easier in patients treated with SB.