專題討論2:目前在介入放射和腔內血管治療的進展和技術
Current Issues and New Techniques in Interventional Radiology and Endovascular Therapy

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S2-7
Drug-eluting Bead TACE for Hepatocellular Carcinoma
劉益勝
成大醫院放射線診斷部


  Hepatocellular carcinoma (HCC), the most common primary malignant tumor of the liver, is one of the most lethal malignancies. Curative therapies including liver transplantation and resection are applicable in only 30–40% of HCC patients. Therefore, most patients are suitable only for locoregional or palliative therapies
  Transarterial chemoembolization (TACE) is one of the preferred treatments for patients with HCC who are not suitable for curative therapy. Conventional TACE involves intra-arterial infusion of a viscous emulsion of an ethiodized oil (e.g., lipiodol) and a chemotherapeutic agent such as doxorubicin, followed by an injection of gelatin sponge particles or other agents to embolize the blood vessel. Ideally, TACE should result in a maximum sustained concentration of chemotherapeutic agent within the tumor with minimal systemic exposure. Additionally, TACE should obstruct the tumor vessels without obstructing blood supply to the surrounding tissue.
  To release cytotoxic drugs (e.g., epirubicin or doxorubicin) in a controlled and sustained manner, drug-eluting beads (DEBs) have been introduced to TACE for transarterial treatment of HCC. These microspheres allow local delivery of high concentrations of chemotherapeutic agents to the tumor, with systemic concentrations comparable to conventional chemotherapeutic regimens. The use of DEB can reduce the occurrence of common adverse events (AEs) such as abdominal pain, fever, nausea, and vomiting. Studies highlighting the use of DEB with TACE for the treatment of HCC have shown similar or better results compared to conventional TACE with lipiodol.