Pisa University Hospital, University of Pisa, Pisa, IT, Italy.
Cardiovasc Intervent Radiol. 2012 Oct;35(5):980-5. doi: 10.1007/s00270-011-0287-7. Epub 2011 Oct 19.
Tranarterial chemoembolization (TACE) has been established by a meta-analysis of randomized controlled trials as the standard of care for nonsurgical patients with large or multinodular noninvasive hepatocellular carcinoma (HCC) isolated to the liver and with preserved liver function. Although conventional TACE with administration of an anticancer-in-oil emulsion followed by embolic agents has been the most popular technique, the introduction of embolic drug-eluting beads has provided an alternative to lipiodol-based regimens. Experimental studies have shown that TACE with drug-eluting beads has a safe pharmacokinetic profile and results in effective tumor killing in animal models. Early clinical experiences have confirmed that drug-eluting beads provide a combined ischemic and cytotoxic effect locally with low systemic toxic exposure. Recently, the clinical value of a TACE protocol performed by using the embolic microsphere DC Bead loaded with doxorubicin (DEBDOX; drug-eluting bead doxorubicin) has been shown by randomized controlled trials. An important limitation of conventional TACE has been the inconsistency in the technique and the treatment schedules. This limitation has hampered the acceptance of TACE as a standard oncology treatment. Doxorubicin-loaded DC Bead provides levels of consistency and repeatability not available with conventional TACE and offers the opportunity to implement a standardized approach to HCC treatment. With this in mind, a panel of physicians took part in a consensus meeting held during the European Conference on Interventional Oncology in Florence, Italy, to develop a set of technical recommendations for the use of DEBDOX in HCC treatment. The conclusions of the expert panel are summarized.
经随机对照试验的荟萃分析证实，经肝动脉化疗栓塞术（TACE）已成为不能手术的、孤立于肝脏且肝功能保存完好的大或多结节非侵袭性肝细胞癌（HCC）患者的标准治疗方法。尽管含抗癌剂油乳剂的常规 TACE 联合栓塞剂的应用是最受欢迎的技术，但载药微球的引入为载碘油方案提供了一种替代方法。实验研究表明，载药微球栓塞 TACE 具有安全的药代动力学特性，并在动物模型中有效杀伤肿瘤。早期临床经验证实，载药微球在局部提供缺血和细胞毒性的联合作用，而全身毒性暴露较低。最近，通过随机对照试验证实了载多柔比星的栓塞微球（DEBDOX；载药微球多柔比星）的 TACE 方案的临床价值。常规 TACE 的一个重要局限性是技术和治疗方案的不一致性。这一局限性阻碍了 TACE 作为一种标准肿瘤治疗方法的接受。载多柔比星的栓塞微球提供了常规 TACE 无法提供的一致性和可重复性水平，并为 HCC 治疗提供了实施标准化方法的机会。有鉴于此，一组医生参加了在意大利佛罗伦萨举行的欧洲介入肿瘤学会议期间举行的共识会议，以制定一套关于在 HCC 治疗中使用 DEBDOX 的技术建议。专家组的结论总结如下。
