Abstract No. 344: Chemoembolization of Unresectable HCC with Embolizing Microspheres Loaded with Chemotherapeutic Agent

To present the results of Italian multi-center registry using HepaSphere™ microspheres (Biosphere Medical) loaded with chemotherapeutic agent (Doxorubicin or Epirubicin) for TACE in patients with unresectable HCC. From 12/05 to 03/07, 50 pts (36 M,14 F, mean age 68.4) with HCC were treated by selective TACE using HepaSphere™ (50-100 μm or 100-150 μm), loaded with Doxorubicin (18 pts, mean 43.61 mg) or Epirubicin (32 pts, mean 44.5 mg). Diameters of lesions were 20 to 100 mm. Drug solution (50 mg chemotherapeutic in 5ml NaCl 0,9% or in 5 ml contrast medium [Visipaque 270 mg/ml]) mixed with Hepaspheres toke 15-20 min to be absorbed. The suspension was then used as a regular embolic agent to perform selective TACE after a futher addition of 15 ml of c.m. No major complications occurred, excluding a mild pancreatitis resolved by medical therapy. 9/50 had a post-embolization syndrome that seemed less severe than after conventional TACE. 30 days mortality was 0%; overall mortality was 4/50 (8%): 1 case at 2 months (hepatic failure), 2 cases at 5 and 6 months (cardiovascular disease) and 1 case at 9 months (progressive disease). Follow-up was scheduled at 1, 3, 6 and 12 months: 30 days-CT on 50 patients showed good results with complete necrosis in 27/50 (54%), partial necrosis (50-90%) in 16/50 (32%), incomplete necrosis (0-49%) in 7/50 (14%); 6 months-CT on 35 patients showed complete necrosis in 10/35 (28.6%), partial necrosis in 6/35 (17.1%) and incomplete necrosis in 5/35 (14.3%) with local recurrence and/or satellite lesions. 21 pts underwent another treatment as a further procedure of TACE using HepaSphere™, RF Ablation, conventional TACE or chemotherapy. Our experience shows that TACE using HepaSphere™ is feasible, with low complications rate and promising efficacy. The prolonged contact between drug and tumor should bring additional efficacy and reduced adverse effects of the chemotherapeutic agents compared to standard TACE. In case of incomplete response, additional treatment can be performed without difficulties. Longer follow-up on larger series are mandatory to confirm these preliminary results.