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Stambo et al. LC Bead embolization of hepatic neoplasms

standard of care for colorectal liver metastasis. TACE whether this case series could provide insight into
has been an effective palliative therapy for malignant whether treatment methods are associated with
tumors of the liver for many years. [4-8] TACE has treatment response.
shown improved patient survival rates compared to
conservative treatment for various types of malignant METHODS
liver tumors. [6-9] The palliative nature of transcatheter
embolizations has shown improved patient survival Computed tomography positron emission tomography
and quality of life as compared to placebo and systemic (CT-PET) and/or magnetic resonance imaging (MRI)
based chemotherapy. [10] TACE is a useful palliative studies were reviewed prior to all procedures to
procedure with its ability to simultaneously infuse guide endovascular treatment [Figure 1]. Four board
concentrated dose of chemotherapeutic drug combined certified interventional radiologists reviewed all pre
with embolization particles. [5-8] This combination procedure imaging for each patient and all 4 actually
produces elevated local chemotherapeutic drug levels performed the LC Bead chemoembolizations. This
along with vascular occlusion of the feeding vessels was a retrospective study and no ethical approval was
killing the tumor resulting in reduced systemic toxicity obtained for this study. Informed consent was obtained
without causing collateral damage to the surrounding prior to all interventional procedures. All patients with
liver parenchyma. metastatic colorectal metastases or HCC over a period
of 1 year were included in this study. All of the colorectal
LC Bead drug eluting beads [Biocompatibles UK Ltd, metastasis patients were treated with systemic
Farnham (a BTG group company)] are approved by chemotherapy prior to endovascular intervention.
the Food and Drug Administration for locoregional All patients were treated with drug eluting beads
embolization. Like conventional TACE, drug eluting during the study. The time frame between completing
beads are available for precision transarterial chemotherapy and initiating the endovascular treatment
chemoembolization. [11-13] However, they are different was 3-6 months. Subsequently, a follow-up CT-PET
in the way they deliver the drug to the tumor. The scan demonstrated progressive liver metastasis not
beads are compressible sulphonate modified polyvinal improved on intravenous chemotherapy. As for the
alcohol hydrogel microspheres. [14] The drug-eluting HCC patients, once deemed unresectable, they were
beads can be loaded with some positively-charged included in this study. The decision to treat was based
chemotherapeutic agents such as doxorubicin on a multidisciplinary approach including the patient’s
hydrochroride or irinotecan hydrochloride. There is oncologist, surgical oncologist and interventional
an ion exchange mechanism which creates the active radiologist. The treatment pathway was defined by
attraction of the drug to the beads. Just like TACE, tumor type and then the appropriate chemotherapeutic
the beads are delivered to their exact location with agent to be used on that type of liver neoplasm. The
fluoroscopic guided transarterial catheters but this treatment pathway included pre-procedural imaging,
time the drug is loaded into the beads. [5,15] The mixture performing the intra-arterial embolization and then the
of beads with doxorubicin or irinotecan can be easily follow-up CT-PET imaging for evaluation of changes
in liver mass. Data were collected and patients were
loaded in the pharmacy 2 h prior to delivering them
to the patient. The 2 h of soaking allows the drug A
and beads to interact effectively according to the
manufacturer. [16] The controlled release of the drug
from the drug eluting beads (DEB) demonstrates
very little or no post embolization syndrome as
compared to conventional TACE procedures. The LC
beads maintain a significantly high intratumoral drug
concentration in the tumor bed for a 2-week period. R L
This controlled release process may be more effective
than conventional TACE. Systemic toxicity is reduced
due to a combination of increase late effects and
precise arterial deposition of the beads into the tumor
as compared to conventional TACE.

LC Bead embolization can utilize both doxorubicin P
and irinotecan eluting beads for primary hepatomas,
colorectal metastasis and a variety of other liver Figure 1: Contrast enhanced computed tomography image of the
abdomen demonstrates a large enhancing tumor right hepatic lobe
metastases. The purpose of this study is to determine consistent with biopsy proven hepatocellular carcinoma
142 Hepatoma Research ¦ Volume 3 ¦ July 12, 2017