Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Int J Clin Oncol. 2012 Aug;17(4):306-15. doi: 10.1007/s10147-012-0445-1. Epub 2012 Jul 18.
Gelatin sponge and polyvinyl alcohol particles have been the most popular particulate embolic agents for transarterial chemoembolization (TACE) of liver tumors. Over the last decade, calibrated microspheres have been introduced and increasingly used in liver tumor embolization in Western countries. In addition, drug-eluting beads (DEB) have been introduced for sustained local drug release. Such long-awaited spherical embolic agents will be introduced in Japan in the near future. The advantages of these microspheres are that particles are uniform in size and shape, and easy to inject through a microcatheter. They can travel distally to vessels corresponding to the particle size; in other words, the occlusion level can be predicted according to the particle size chosen. Thus, new bland microspheres and DEB may bring a significant advancement to embolization for primary liver tumors as well as hepatic metastases from various cancers. However, at this point, the published data suggests that both conventional TACE and DEB-TACE are equally effective for treatment of unresectable hepatocellular carcinoma, when patients are carefully selected. Therefore, indication, patient selection, and embolization techniques will be essential in order to individually adapt newer embolic agents based on oncological, anatomical and technical considerations.
明胶海绵和聚乙烯醇颗粒一直是用于肝肿瘤经动脉化疗栓塞术（TACE）的最常用的微粒栓塞剂。在过去的十年中，微球已被引入并在西方国家的肝肿瘤栓塞中越来越多地使用。此外，载药微球（DEB）已被引入用于持续局部药物释放。这些期待已久的球形栓塞剂将在不久的将来在日本推出。这些微球的优点是颗粒大小和形状均匀，易于通过微导管注射。它们可以向与颗粒大小相对应的血管远端输送；换句话说，可以根据选择的颗粒大小来预测闭塞程度。因此，新型的无栓塞微球和 DEB 可能会为原发性肝癌以及各种癌症的肝转移带来显著的栓塞治疗进展。然而，目前的研究数据表明，在仔细选择患者的情况下，传统 TACE 和 DEB-TACE 对于治疗不可切除的肝细胞癌同样有效。因此，为了根据肿瘤学、解剖学和技术考虑因素对新型栓塞剂进行个体化适应，适应证、患者选择和栓塞技术将是至关重要的。
