Repeated transarterial chemoembolization with degradable starch microspheres (DSMs-TACE) of unresectable hepatocellular carcinoma: A prospective pilot study

Antonio Orlacchio, Fabrizio Chegai, Simona Francioso, Stefano Merolla, Serena Monti, Mario Angelico, Giuseppe Tisone, Lorenzo Mannelli

Research output: Contribution to journalArticlepeer-review


Objective: The aims of this study were to: a) evaluate tumor response rates using modi-fied-Response-evaluation-criteria-in-solid-tumors (mRecist) criteria, b) evaluate safety of Degradable Starch Microspheres Trans-arterial-chemo-embolization (DSMs-TACE) for unresectable hepa-tocellular-carcinoma (HCC) treatment. Materials and Methods: We prospectively enrolled 24 HCC cirrhotic patients (21/3 M/F, mean age 66.3 years) to be treated with repeated DSMs-TACE procedures, performed at 4-6 week intervals on the basis of tumor response and patients tolerance. Clinical and biochemical evaluations were performed before and after each procedure. Treatment response was also assessed by Computed-tomography (CT) or Magnetic-resonance-imaging (MRI)-scan 4-6 weeks following each procedure. Results: In our experience, DSMs-TACE was both safe and effective. A total of 53 DSMs-TACE procedures were performed (2.2 per patient). No procedure-related death was observed. Complete Response (CR) was observed in 5/24 (20.8%), 4/17 (23.5%) and 5/12 (41.6%) patients after the first, second and third procedure, respectively. At the end of each treatment, all patients experienced at least a partial response. At the end of the repeated procedures, no differences between mono-or bi-lobar disease were observed in patients with CR (64.2% vs 50%; p=ns). In most cases, treatment discontinuation was due to worsening liver function. Conclusion: DSMs-TACE is a valid, well-tolerated alternative treatment to Lipiodol-TACE or DEB-TACE, as it has demonstrated to achieve a relatively high percentage of complete tumor necrosis. CR rates were similar between patients with mono-or bi-lobar disease indicating the possibility of carrying-out repeated procedure in a safe and effective way in both types of patients.

Original languageEnglish
Pages (from-to)637-645
Number of pages9
JournalCurrent Medical Imaging Reviews
Issue number4
Publication statusPublished - Jan 1 2018


  • Degradable starch microspheres
  • HCC cirrhotic patients
  • Hepatocellular carcinoma
  • Locoregional therapies
  • Recurrence-free survival
  • Transcatheter arterial chemoembolization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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