ABSTRACT
Transarterial chemoembolization (TACE) using doxorubicin-eluting beads (DEBs) have been introduced as a novel device which ensures more sustained and tumor-selective drug delivery and permanent embolization compared to conventional TACE with lipiodol. Studies highlighting the use of TACE with DEBs for the treatment of hepatocellular carcinoma (HCC) have shown similar or better results compared to conventional TACE with lipiodol. TACE with DEBs is increasingly being performed interchangeably with conventional TACE. This review assessed the characteristics, clinical outcomes and future direction of TACE with DEBs compared to conventional TACE.
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Keywords: Drug eluting beads; Hepatocellular carcinoma; Transarterial chemoembolization
INTRODUCTION
According to Barcelona Clinic Liver Cancer (BCLC) tumor staging and management,
1 transarterial chemoembolisation (TACE) is recommended as the first-line therapy for unresectable intermediate-stage HCC (stage B). This evidence-based position has been established by the results of three studies showing that TACE significantly improves patient survival as compared with the best supportive care.
234 TACE is one of the commonly used treatments for patients with HCC who are not suitable for curative therapy.
56 And it is also considered the standard of care for patients with HCC who are not suitable for surgical treatment but limited to the liver because it can preserve liver function.
27 Typically, conventional TACE involves injection of chemotherapeutic agents mixed with lipiodol followed by embolic particles into tumor feeding vessel.
8 An important limitation of conventional TACE is the inconsistency in the technique and the treatment schedules. To compensate this limitation, Transarterial chemoembolization (TACE) using doxorubicin-eluting beads (DEBs) was introduced as a novel device capable of ensuring more sustained and tumor-selective drug delivery and permanent embolization.
9 These microspheres allow local delivery of high concentrations of chemotherapeutic agents to the tumor without elevating systemic concentrations. Therefore, adverse events which typically occur with conventional TACE can be reduced with the use of DEBs.
91011 TACE with DEBs is increasingly being performed interchangeably with conventional TACE in many institutions throughout the world, it is imperative to review current status of TACE with DEBs compared to conventional TACE and anticipate the future impact as a management of HCC. This review critically assessed characteristics of each modality, clinical outcomes and future direction of TACE with DEBs compared to conventional TACE.
Characteristics of conventional TACE and TACE with DEBs
The procedure of TACE has technically and scientifically evolved since its introduction almost 30 years ago. Generally, conventional TACE involves intra-arterial infusion of a lipidol and a chemotherapeutic agent such as doxorubicin, followed by an injection of embolic material such as gelatin sponge particles or other agents.
12 Lipiodol is a key ingredient of TACE because it has unique properties such as drug-carrying, tumor-seeking, and embolizing effects.
13 Although the mechanism is not clearly understood, lipiodol is absorbed by a pump in the tumor cell wall and then transferred to inside of the intracellular space. After then, this pump is disabled by hypoxia within the tumor, thus lipiodol retained within the cell. Typically it could be retained by HCC for months, even up to a year, while it is washed out from normal or cirrhotic liver within 4 weeks. The embolizing agent not only helps lipiodol to be retained selectively in HCC but also reduces drug washout from the tumor and induces ischemic necrosis. An important limitation of conventional TACE is that the technique and treatment schedules can be heterogeneous
14 and this makes the results reported in the literature very inconsistent. Moreover, some HCC does not exhibit lipiodol retention which may bring lower effectiveness of the treatment.
1516
DEBs are microsphere which can carry calibrated doxorubicin and they can release cytotoxic drugs (e.g., epirubicin or doxorubicin) in a controlled and sustained manner.
1718 The microspheres can actively sequester oppositely charged drugs through an ionexchange mechanism. Initial in vitro studies, doxorubicin can be loaded maximally by the DEBs to approximately 45 mg/ml hydrated beads, irrespective of the size of beads.
19 Considering both practical therapeutic dose and optimum handling characteristics, a loading of 37.5 mg doxorubicin/ml beads is currently recommended. According to bead size, animal pharmacokinetic study showed that higher doxorubicin plasma levels were detected in the smaller-size (100-300 µm) beads group when two sizes of doxorubicin-eluting beads (DEB;100-300 vs. 700-900 µm) loaded with same amount of doxorubicin was compared.
20 This result is due to increased surface area of the smaller beads, inducing a greater burst release of doxorubicin. Per treatment, the maximum recommended dose is 150 mg of doxorubicin. The primary mode of action of DEBs is to embolize the cancer vasculature, and the second mode is to deliver doxorubicin locally to the tumor artery. After the microspheres are delivered through catheters or microcatheters directly into the hepatic artery, doxorubicin elutes locally and is concentrated in the tumor with minimum levels in normal liver tissue. In this way, tumor concentrations are maximized and systemic concentrations are kept to a minimum limiting damage to normal liver tissue.
Clinical outcome of TACE with DEBs
Initial phase I/II TACE with DEBs performed in China tested the dose limiting toxicity and safety as well as tumor response and pharmacokinetics of doxorubicin.
17 Phase I trial was a dose-escalating study from 25 mg to 150 mg doxorubicin in cohorts of 3 patients (total of 15 patients). A 150 mg doxorubicin dose was used for the phase II study. No dose-limiting toxicity was observed for up to 150 mg doxorubicin and treatment relevant adverse events were reported in 11.4%. Mean low peak plasma doxorubicin concentration was 49.4±23.7 ng/ml and there was no treatment-related death. After two courses of TACE, the partial and complete response rates were 50 and 0%, respectively, according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria and 63.3 and 6.7% respectively, by modified RECIST criteria at 1 month after the second TACE. Afterward, several small sized phase II study results about TACE with DC-beads in unresectable HCC mainly with intermediate BCLC stage were reported.
921 According to these studies, overall objective response was about 59.6-81.8% and 1- and 2-year survival was 65-92.5% and 55-88.9%, respectively. The rate of severe procedure-related complications was about 3.2%.
Previous comparisons between TACE with DEBs and conventional TACE with lipiodol in intermediated stage HCC demonstrated slightly conflicting results. A recent meta-analysis based on seven studies (n=693) demonstrated that the two procedures showed equivalent results, strongly suggested the lack of difference in tumor response between two procedures.
22 Meanwhile, meta-analysis presented in 2014 by Han et al,
23 comparison of current conventional TACE to TACE with DEBs in the treatment of liver carcinoma showed different results. This systematic review included three randomized controlled trials and two case-control studies. In the largest randomized controlled trial by Lammer,
10 overall population did not show significant difference in terms of disease control, but the subgroup analyses showed that the overall survival and disease control were statistically higher (
P=0.038 and
P=0.026, respectively) in TACE with DEBs group than the conventional TACE group in patients (67%) with more advanced disease (Child-Pugh B, ECOG 1, bilobar or recurrent disease). And the incidence of severe adverse events within 30 days of a procedure was consistently lower, and elevation of AST as well as ALT was significantly less in the TACE with DEBs group. In the largest retrospective study by Song, treatment response was significantly better in the TACE with DEBs group than that of compared to the conventional TACE group (
P=0.001) and this difference in the treatment response was shown in intermediate state from subgroup analysis according to BCLC stage (
P=0.001).
24 From these result, TACE with DEBs have shown better or at least similar result in the studies between TACE with DEBs and conventional TACE with lipiodol.
91725 Furthermore, we might conclude that TACE with DEBs could improve the clinical effectiveness in patients with more advanced HCC and be safe in high-risk patients.
For advanced HCC such as BCLC stage C, the use of TACE with DEBs in advanced-stage HCC has not been well studied. According to the BCLC algorithm, patients with advanced stage HCC (BCLC-C) are recommended for systemic treatment or palliative therapy. In a small retrospective trial with TACE with DEBs for patients with advanced HCC (n=80), the median progression free survival and overall survival were 5.1 months [95 % confidence interval (CI): 4.1-7.7] and 13.3 months (95 % CI: 10.1-18.6) respectively.
26 The other retrospective study, with treatment of TACE with DEBs, the overall median survival was 13.5 months (range, 8.2-18.7 months) and severe adverse events were minimal (1%). In subgroup analysis, survival of patients with Child-Pugh A disease was 17.8 months.
27 Based on the results of the these studies, compared with median survivals of 10.7 months and 6.5 months for the sorafenib groups in the SHARP and Asia-Pacific trials,
2829 it seems that patients with Child-Pugh class A disease with advanced disease may fare better with aggressive loco-regional treatment in the form of TACE with DEBs than systemic monotherapy with sorafenib. Recently, Printer et al.
30 reported higher survival in patients with advanced (BCLC C) stage disease treated with conventional TACE (9.2 months) than patients treated with sorafenib (7.4 months;
P=0.377). These results may indicate that conventional TACE as well as TACE with DEBs is also as effective as sorafenib in the treatment of advanced HCC. TACE is still commonly used in advanced HCC as palliative indication even after sorafenib is the new standard in this state, and comparable to sorafenib in some selected patients, although the mechanism of each treatment is different.
Currently, there are several trials to analyze the potential benefit by addition of sorafenib to conventional TACE or TACE with DEBs in the patients with HCC at a more advanced stage. The rationale for this combination therapy is based on the fact that TACE induces ischemia and can stimulate tumor angiogenesis and the use of sorafenib could reduce angiogenesis. Recently, Pawlik et al. reported trial of combination therapy of TACE with DEBs and sorafenib in a group of 35 patients (64 %, BCLC stage C). In their study, the incidence of grade 3-4 toxicities are reported in 17 % and objective response rate was 58 % based on EASL criteria.
31 The potential of this combination approach has not yet been fully verified in clinical trials, and many unanswered questions remain requesting further study.
CONCLUSIONS
To compensate limitation of conventional TACE, TACE with DEBs was introduced as a novel device capable of ensuring more sustained and tumor-selective drug delivery and permanent embolization allowing local delivery of high concentrations of chemotherapeutic agents to the tumor without elevating systemic concentrations. TACE with DEBs showed better or at least similar results compared with conventional TACE and showed increased clinical effectiveness in patients with more advanced HCC with tolerable safety. In even more advanced HCC (BCLC stage C), it showed similar results compared with sorafenib and these results support the application of TACE with DEBs in the treatment of HCC can be expandable to more advanced HCC in the future.
ACKNOWLEDGMENTS
Acknowledgments
This work was supported by clinical research grant in 2014 from Pusan National University Hospital.
FOOTNOTES
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Conflicts of Interest: The authors declare that there is no conflict of interests regarding the publication of this paper.
Abbreviations
Barcelona Clinic Liver Cancer
doxorubicin-eluting beads
Response Evaluation Criteria in Solid Tumors
Transarterial chemoembolization
REFERENCES
- 1. Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 2002;35:519-524. 11870363.
- 2. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology 2003;37:429-442. 12540794.
- 3. Llovet JM, Real MI, Montaña X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002;359:1734-1739. 12049862.
- 4. Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002;35:1164-1171. 11981766.
- 5. Thomas MB, Jaffe D, Choti MM, Belghiti J, Curley S, Fong Y, et al. Hepatocellular carcinoma: consensus recommendations of the National Cancer Institute Clinical Trials Planning Meeting. J Clin Oncol 2010;28:3994-4005. 20679622.
- 6. Ramsey DE, Kernagis LY, Soulen MC, Geschwind JF. Chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol 2002;13(9 pt 2):S211-S221. 12354839.
- 7. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology 2005;42:1208-1236. 16250051.
- 8. Geschwind J-FH. Chemoembolization for hepatocellular carcinoma: where does the truth lie? J Vasc Interv Radiol 2002;13:991-994. 12397119.
- 9. Varela M, Real MI, Burrel M, Forner A, Sala M, Brunet M, et al. Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 2007;46:474-481. 17239480.
- 10. Lammer J, Malagari K, Vogl T, Pilleul F, Denys A, Watkinson A, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 2010;33:41-52. 19908093.
- 11. Granberg D, Eriksson LG, Welin S, Kindmark H, Janson ET, Skogseid B, et al. Liver embolization with trisacryl gelatin microspheres (embosphere) in patients with neuroendocrine tumors. Acta Radiol 2007;48:180-185. 17354139.
- 12. Lencioni R. Loco-regional treatment of hepatocellular carcinoma. Hepatology 2010;52:762-773. 20564355.
- 13. Liapi E, Geschwind JF. Transcatheter arterial chemoembolization for liver cancer: is it time to distinguish conventional from drug-eluting chemoembolization? Cardiovasc Intervent Radiol 2011;34:37-49. 21069333.
- 14. Marelli L, Stigliano R, Triantos C, Senzolo M, Cholongitas E, Davies N, et al. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol 2007;30:6-25. 17103105.
- 15. Poyanli A, Rozaneş I, Acunaş B, Sencer S. Palliative treatment of hepatocellular carcinoma by chemoembolization. Acta Radiol 2001;42:602-607. 11736709.
- 16. Lee JK, Chung Y-H, Song B-C, Shin JW, Choi W-B, Yang SH, et al. Recurrences of hepatocellular carcinoma following initial remission by transcatheter arterial chemoembolization. J Gastroenterol Hepatol 2002;17:52-58. 11895553.
- 17. Poon RT, Tso WK, Pang RW, Ng KK, Woo R, Tai KS, et al. A phase I/II trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drug-eluting bead. Clin Gastroenterol Hepatol 2007;5:1100-1108. 17627902.
- 18. Nicolini A, Martinetti L, Crespi S, Maggioni M, Sangiovanni A. Transarterial chemoembolization with epirubicin-eluting beads versus transarterial embolization before liver transplantation for hepatocellular carcinoma. J Vasc Interv Radiol 2010;21:327-332. 20097098.
- 19. Lewis AL, Gonzalez MV, Lloyd AW, Hall B, Tang Y, Willis SL, et al. DC Bead: In Vitro Characterization of a Drug-delivery Device for Transarterial Chemoembolization. J Vasc Interv Radiol 2006;17:335-342. 16517780.
- 20. Lewis AL, Taylor RR, Hall B, Gonzalez MV, Willis SL, Stratford PW. Pharmacokinetic and safety study of doxorubicin-eluting beads in a porcine model of hepatic arterial embolization. J Vasc Interv Radiol 2006;17:1335-1343. 16923981.
- 21. Malagari K, Chatzimichael K, Alexopoulou E, Kelekis A, Hall B, Dourakis S, et al. Transarterial chemoembolization of unresectable hepatocellular carcinoma with drug eluting beads: results of an open-label study of 62 patients. Cardiovasc Intervent Radiol 2008;31:269-280. 17999110.
- 22. Gao S, Yang Z, Zheng Z, Yao J, Deng M, Xie H, et al. Doxorubicin-eluting bead versus conventional TACE for unresectable hepatocellular carcinoma: a meta-analysis. Hepatogastroenterology 2013;60:813-820. 23282741.
- 23. Han S, Zhang X, Zou L, Lu C, Zhang J, Li J, et al. Does drug-eluting bead transcatheter arterial chemoembolization improve the management of patients with hepatocellular carcinoma? A meta-analysis. PLoS One 2014;9:e102686. 25083860.
- 24. Song MJ, Chun HJ, Song DS, Kim HY, Yoo SH, Park CH, et al. Comparative study between doxorubicin-eluting beads and conventional transarterial chemoembolization for treatment of hepatocellular carcinoma. J Hepatol 2012;57:1244-1250. 22824821.
- 25. Song MJ, Park CH, Kim JD, Kim HY, Bae SH, Choi JY, et al. Drug-eluting bead loaded with doxorubicin versus conventional Lipiodol-based transarterial chemoembolization in the treatment of hepatocellular carcinoma: a case-control study of Asian patients. Eur J Gastroenterol Hepatol 2011;23:521-527. 21537127.
- 26. Kalva S, Pectasides M, Liu R, Rachamreddy N, Surakanti S, Yeddula K, et al. Safety and effectiveness of chemoembolization with drugeluting beads for advanced-stage hepatocellular carcinoma. Cardiovasc Intervent Radiol 2014;37:381-387. 23754191.
- 27. Prajapati HJ, Dhanasekaran R, El-Rayes BF, Kauh JS, Maithel SK, Chen Z, et al. Safety and efficacy of doxorubicin drug-eluting bead transarterial chemoembolization in patients with advanced hepatocellular carcinoma. J Vasc Interv Radiol 2013;24:307-315. 23375519.
- 28. Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008;359:378-390. 18650514.
- 29. Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, doubleblind, placebo-controlled trial. Lancet Oncol 2009;10:25-34. 19095497.
- 30. Pinter M, Hucke F, Graziadei I, Vogel W, Maieron A, Königsberg R, et al. Advanced-stage hepatocellular carcinoma: transarterial chemoembolization versus sorafenib. Radiology 2012;263:590-599. 22438359.
- 31. Pawlik TM, Reyes DK, Cosgrove D, Kamel IR, Bhagat N, Geschwind JF. Phase II trial of sorafenib combined with concurrent transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma. J Clin Oncol 2011;29:3960-3967. 21911714.
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- Influencing Factors and Nomogram Model Construction of Cancer-related Fatigue in Primary Liver Cancer Patients Post-TACE Treatment
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Cancer Biotherapy and Radiopharmaceuticals.2023; 38(8): 512. CrossRef - An In Vitro Comparative Study of Three Drug-Eluting Beads Loaded with Raltitrexed
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Wenchao Hu, Guohong Cao, Shengli Ye, Jianfeng Xu, Jing Chen, Guoliang Shao
Medicine.2023; 102(24): e34054. CrossRef - Safety, efficacy, and survival of drug-eluting beads-transarterial chemoembolization vs. conventional-transarterial chemoembolization in advanced HCC patients with main portal vein tumor thrombus
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Somin Lee, Yong Yeon Jeong, Byung Chan Lee, Sang Soo Shin, Suk Hee Heo, Hyoung Ook Kim, Chan Park, Won Gi Jeong
Journal of Korean Medical Science.2023;[Epub] CrossRef - Comparison of tumor response following conventional versus drug-eluting bead transarterial chemoembolization in early- and very early-stage hepatocellular carcinoma
Murtuza Razi, Syed Safiullah, Jianping Gu, Xu He, Mustafa Razi, Jie Kong
Journal of Interventional Medicine.2022; 5(1): 10. CrossRef - Drug-eluting bead trans-arterial chemoembolization combined with microwave ablation therapy vs. microwave ablation alone for early stage hepatocellular carcinoma: a preliminary investigation of clinical value
Juanfang Liu, Wenguang Zhang, Huibin Lu, Hongbin Li, Xueliang Zhou, Jing Li, Xinwei Han
Journal of Cancer Research and Clinical Oncology.2022; 148(7): 1781. CrossRef - Conventional versus drug-eluting bead transarterial chemoembolization: A better option for treatment of unresectable hepatocellular carcinoma
Murtuza Razi, Gu Jianping, He Xu, Mohammed Jameeluddin Ahmed
Journal of Interventional Medicine.2021; 4(1): 11. CrossRef - A Four-Step Cascade Drug-Release Management Strategy for Transcatheter Arterial Chemoembolization (TACE) Therapeutic Applications
Ying-Jiun Hsieh, Hung-Wei Cheng, Hung-Yu Chen, Ming-Wei Lee
Polymers.2021; 13(21): 3701. CrossRef - Hepatocellular carcinoma locoregional therapies: Outcomes and future horizons
Mina S Makary, Stuart Ramsell, Eric Miller, Eliza W Beal, Joshua D Dowell
World Journal of Gastroenterology.2021; 27(43): 7462. CrossRef - Optimized Loading of Idarubicin in CalliSpheres® Drug-Eluting Beads and Characterization of Release Profiles and Morphological Properties
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Pharmaceutics.2021; 13(6): 799. CrossRef - Biodegradable 131Iodine‐Labeled Microspheres: Potential Transarterial Radioembolization Biomaterial for Primary Hepatocellular Carcinoma Treatment
Fuwen Pang, Yuhao Li, Wenjie Zhang, Chunchao Xia, Qing He, Zhenlin Li, Liu Xiao, Simin Song, Ping Dong, Huijun Zhou, Tuo Shao, Huawei Cai, Lin Li
Advanced Healthcare Materials.2020;[Epub] CrossRef - The Comprehensive Analysis of Efficacy and Safety of CalliSpheres® Drug-Eluting Beads Transarterial Chemoembolization in 367 Liver Cancer Patients: A Multiple-Center, Cohort Study
Zhiyi Peng, Guohong Cao, Qinming Hou, Ling Li, Shihong Ying, Junhui Sun, Guanhui Zhou, Jian Zhou, Xin Zhang, Wenbin Ji, Zhihai Yu, Tiefeng Li, Dedong Zhu, Wenhao Hu, Jiansong Ji, Haijun Du, Changsheng Shi, Xiaohua Guo, Jian Fang, Jun Han, Wenjiang Gu, Xia
Oncology Research Featuring Preclinical and Clinical Cancer Therapeutics.2020; 28(3): 249. CrossRef - Locoregional treatments for hepatocellular carcinoma: Current evidence and future directions
Riccardo Inchingolo, Alessandro Posa, Martin Mariappan, Stavros Spiliopoulos
World Journal of Gastroenterology.2019; 25(32): 4614. CrossRef - Analysis of Lipiodol uptake in angiography and computed tomography for the diagnosis of malignant versus benign hepatocellular nodules in cirrhotic liver
Marcel C. Langenbach, Thomas J. Vogl, Isabelle von den Driesch, Benjamin Kaltenbach, Jan-Erik Scholtz, Renate M. Hammerstingl, Tatjana Gruber-Rouh
European Radiology.2019; 29(12): 6539. CrossRef - An investigation of efficacy, safety, and prognostic factors of drug‐eluting beads‐transarterial chemoembolization operation with CalliSpheres® Microspheres in treating Chinese hepatocellular carcinoma patients
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Technology in Cancer Research & Treatment.2018;[Epub] CrossRef - Early treatment response to transcatheter arterial chemoembolization is associated with time to the development of extrahepatic metastasis and overall survival in intermediate-stage hepatocellular carcinoma
Sung Won Lee, Hae Lim Lee, Nam Ik Han, Jeong Won Jang, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon
Cancer Chemotherapy and Pharmacology.2017; 79(1): 81. CrossRef - New concepts in embolotherapy of HCC
F. Pesapane, N. Nezami, F. Patella, J. F. Geschwind
Medical Oncology.2017;[Epub] CrossRef - Loading and Elution Characteristics of Quadrasphere Microspheres Loaded With Bevacizumab
Martin Oselkin, Neda I Sedora-Roman, Bryan A Pukenas, David Kung, Robert W Hurst
Therapeutic Delivery.2017; 8(9): 747. CrossRef - Sustained multiple organ ischaemia after transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma
Young Kim, Jung Kwon, Soon Nam, Jeong Jang, Hyun Jung, Yu Shin, Eun Park, Dong Shim
Experimental and Therapeutic Medicine.2017;[Epub] CrossRef - Challenges of advanced hepatocellular carcinoma
Stefano Colagrande, Andrea L Inghilesi, Sami Aburas, Gian G Taliani, Cosimo Nardi, Fabio Marra
World Journal of Gastroenterology.2016; 22(34): 7645. CrossRef
