PURPOSE To evalutate safety and efficacy of degradable starch microspheres (DSM) as embolic agent in transarterial chemoembolisation (TACE) of unresectable, locally extensive hepatocellular carcinoma (HCC). MATERIALS AND METHODS In this retrospective study, 37 patients with intermediate to advanced HCC treated with ≥ 3 chemoembolisations with doxorubicin/epirubicin and DSM were analysed. Patients were treated with three consecutive chemoembolisations in 4-weekly intervals. Clinical parameters and laboratory findings were obtained from patient records before and after each intervention. Tumour response was assessed after every 3 embolisations by CT/MRI according to modified response evaluation criteria in solid tumours. RESULTS Thirty-seven patients with HCC were treated with 177 DSM-TACEs (3-12/patient, mean 4.8). Disease stages according to the Barcelona Clinic Liver Cancer (BCLC) staging system were: 27 × B, 9 × C, 1 × D. Five patients had uninodular, 32 multinodular (23 bilobar) disease. Three patients had portal vein invasion. Apart from one possibly procedure-related grade 3 complication, only grade 1 adverse events occurred. These were pain reacting to analgesics (23%), transient nausea (11%), vomiting (3%) and post-embolisation syndrome (4%). Transient laboratory changes were bone marrow toxicity (29%) and increase in INR (14%), creatinine (8%) or bilirubin (38%). Tumour response was objective response rate 49%, disease control rate 83%. Median survival was 19 months: 22 months for BCLC stage B and 6.7 months for BCLC stages C + D. Responders had a significantly better prognosis than non-responders. CONCLUSION DSM-TACE of HCC is safe even in patients with advanced disease stages. Tumour response and survival rates were encouraging in our series of patients with locally extensive disease.

中文翻译：

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局部广泛性肝细胞癌（HCC）患者的可降解淀粉微球（DSM）和蒽环类药物的经动脉化学栓塞（TACE）：安全性和有效性。

目的评估可降解淀粉微球（DSM）作为栓塞剂在不可切除，局部广泛性肝细胞癌（HCC）的经动脉化学栓塞（TACE）中的安全性和有效性。材料与方法在这项回顾性研究中，分析了37例中，晚期HCC患者，其中3例接受了3例以上的阿霉素/阿霉素和DSM的化学栓塞治疗。患者每4周接受3次连续的化学栓塞治疗。在每次干预之前和之后，从患者记录中获取临床参数和实验室检查结果。根据实体瘤的改良反应评估标准，每3次栓塞后通过CT / MRI评估肿瘤反应。结果37例HCC患者接受了177例DSM-TACEs治疗（3-12 /患者，平均4.8）。根据巴塞罗那临床肝癌（BCLC）分期系统，疾病分期为：27×B，9×C，1×D。5例患者患有单核，32例多结节（23个双叶）疾病。3例患者门静脉侵犯。除了一项可能与手术相关的3级并发症外，仅发生1级不良事件。这些是对镇痛药（23％），短暂恶心（11％），呕吐（3％）和栓塞后综合症（4％）的疼痛反应。暂时性实验室变化为骨髓毒性（29％）和INR（14％），肌酐（8％）或胆红素（38％）增加。肿瘤反应为客观反应率49％，疾病控制率83％。中位生存期为19个月：BCLC B期为22个月，BCLC C + D期为6.7个月。响应者的预后明显优于无响应者。结论即使在疾病晚期患者中，HCC的DSM-TACE仍是安全的。在我们的一系列局部广泛疾病患者中，肿瘤反应和生存率令人鼓舞。