Transcatheter Arterial Chemoembolization with Doxorubicin-Eluting Superabsorbent Polymer Microspheres in the Treatment of Hepatocellular Carcinoma: Midterm Follow-up

Purpose: To investigate prospectively the safety, tolerability, and efficacy of transarterial chemoembolization using super-absorbent polymer (SAP) microspheres loaded with doxorubicin for the treatment of hepatocellular carcinoma (HCC). Materials and Methods: During the years 2006-2011, 64 patients underwent 144 transarterial chemoembolization with SAP microspheres procedures. Most of the patients were staged as Barcelona Clinic Liver cancer class B (65%). The most frequent underlying liver diseases were hepatitis C (35%) and alcoholic Jiver disease (28%) resulting in Child-Pugh A (73.4%) or Child-Pugh B (17%) liver Cirrhosis. Tumor response was assessed using modified Response Evaluation Criteria in Solid Tumors with magnetic resonance (MR) imaging performed 4-6 weeks after each procedure. Results: Serious adverse events (n = 9) were ischemic or infectious in nature. Transarterial chemoembolization with SAP microspheres resulted in objective response rates of 67.5%, 44.5%, and 25% after first, second, and third sessions. There were 16 patients (25%) who Underwent orthotopic liver transplantation after transarterial chemoembolization with SAP microspheres, of whom 2 experienced recurrent disease. During a median follow-up time of 14 months (range, 2-55 mo), 26 patients (40.5%) died. Median overall and transplant-free survivals were 20.5 months (95% confidence interval, 13.2-27.7) and 18 months (95% confidence interval, 14.2-21.8), respectively. Conclusions: Transarterial chemoembolization with SAP microspheres has an excellent safety profile in cirrhotic patients, even in the presence of advanced liver disease (Child-Pugh B) or advanced stages of HCC. This treatment produced meaningful tumor response fates as assessed by MR imaging.