Safety and Efficacy of Drug-eluting Bead Chemoembolization for Hepatocellular Carcinoma: Comparison of Small-versus Medium-size Particles

Purpose: To compare safety and imaging response with 100-300 mu m and 300-500 mu m doxorubicin drug-eluting bead (DEBs) to determine optimal particle size for chemoembolization of hepatocellular carcinoma (HCC). Materials and Methods: DEB chemoembolization using 100-300 mu m (n = 39) or 300-500 mu m (n = 22) LC beads loaded with 50 mg of doxorubicin was performed in 61 patients with HCC. Patient age, sex, etiology of liver disease, degree of underlying liver disease, tumor burden; and performance status were similar between the groups. All treatments were performed in a single session and represented the patient's first treatment. Toxicities and imaging response in a single index tumor were analyzed Using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) criteria. Results: There was a significantly lower incidence of postembolization syndrome and fatigue after treatment in the 100-300 mu m group (8% and 36%) versus the 300-500 mu m group (40% and 70%) (100-300 mu m group, P = .011; 300-500 mu m group, P = .025). Mean change in tumor size was similar between the two groups based on WHO and EARL criteria and similar rates of objective response, but there was a trend toward a higher incidence of EASL complete response with 100-300 mu m heads versus 300-500 mu m beads (59% vs 36%; P = .114). Conclusions: In DEB chemoembolization for treatment of HCC, 100-300 mu m doxorubicin DEBs are favored over 300-500 mu m doxorubicin DEBs because of lower fates of toxicity after treatment and a trend toward more complete imaging response at initial follow-up.