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Puppala. Hepatoma Res 2019;5:44 I http://dx.doi.org/10.20517/2394-5079.2019.28 Page 5 of 10

Table 2. Various drug-eluting microspheres currently available in the market and their advantages
Types Company Structure Available sizes (μm) Advantages
DC Bead (EU) BTG, London, Polyvinyl alcohol hydrogel 70–150 Largest data available, can be
LC Bead (USA) UK (Now Boston modified with sulfonate 100–300 loaded before embolization and
M1 version is smaller Scientific) groups 300–500 as a secondary action, will elute a
size 500–700 local, controlled and sustained dose
to the tumor after embolization
DC bead LUMI BTG, London, As above and also, covalently 70-150 Visibility on fluoroscopy
UK (Now Boston bound radio-opaque moiety 100-300 and on table cone-beam CT
Scientific)
HepaSphere or Merit Medical, Poly (vinyl alcohol-co- Dry state Compresses by 80% but
QuadraSphere South Jordan, UT, USA sodium acrylate) hydrogel 30–60 returns to shape and size
50–100 becoming predictable and
100–150 conformable.
Hydrated state Entire sphere loads
120–240
200–400
400–600
600–800
Embozene TANDEM Varian Medical Hydrogel core made of Oncozene Tightly calibrated to enable more
Oncozene Systems, Inc. sodium poly (methacrylate) 40 ± 10 choices for embolization.
3100 Hansen Way, and outer biocompatible 75 ± 15 Less than 5% size change on
USA shell of poly bis 100 ± 25 eluting
[trifluoroethoxy] Embozene
phosphazene 40-
75
100
250
400
500
700
900
LifePearl Terumo European Hydrogel network of 100 ± 25 Wide range of drug loading options
Interventional poly ethylene glycol and 200 ± 50 Enhanced suspension
Systems, Leuven, 3-sulfopropyl acrylate 400 ± 50 characteristic.
Belgium Tight calibration and longer
suspension time
DSM – TACE PharmaCept GmbH, Active ingredient – Amilomer 50 Biodegradable.
EMBOCEPTc Berlin, Germany DSM 35/50. Partly Tolerated better as less post
hydrolyzed starch, cross- embolization syndrome.
linked and substituted with Nonimmunogenic
glycerol ether groups

CT: computed tomography; DSM: degradable starch microsphere; TACE: transcatheter arterial chemoembolization

These microspheres or beads are available in various sizes. A very small size bead usage in a large HCC
stands the risk of shunting. Large size bead, on the other hand, can cause proximal occlusion without
enough beads reaching the middle of the tumor. The size of the microsphere should be chosen based on
tumor circulation [25,26] . Routinely, a non-degradable DC bead at 100-300 µm is our preferred size, which
shrinks by 20% upon standing.

DC bead
Consists of polymeric microspheres with the ability to encapsulate chemotherapeutic agents such as
doxorubicin, irinotecan, and epirubicin with hydrogen ions, by electron attraction. It is manufactured by

free radical polymerization of PVA with modification of sulfonate sodium to enable it to encapsulate the
chemotherapeutic agent. DC beads have the most available clinical data and provide a sustained release of
the drug. Patients with DC bead DEM-TACE treatments can receive a higher dose of doxorubicin without
[27]
the undesired systematic circulation of injected drugs in comparison with cTACE . Ninety percent of
patients with unresectable HCC receiving DEM-TACE do not have hepatic artery damage with one- and
[23]
two-year survival rates around 70% and 60%, respectively .