The use of DC bead particles loaded with doxorubicin for the treatment of non-resectable multifocal hepatocellular carcinoma

Background

The use of DC Bead particles loaded with doxorubicin (DCBP-D) in hepatic chemoembolisation (HC), is presented as a first line option for non-curative treatment of multifocal hepatocellular carcinoma (MHC) in an intermediate-advanced state in patients with unresectable tumours without vascular or extra-hepatic dissemination.

Purpose

▶To describe the use of DCBP-D administered by HC in the treatment of non-resectable MHC, making sure that this use is compatible with scientific evidence. ▶To describe risk factors associated with MHC and the toxicity profile derived from treatment. ▶To calculate the expense of one cycle of HC.

Materials and methods

Descriptive and retrospective study which took six months (January-June 2011) of patients treated by HC with DCBP-D for their MHC. The results of tests were taken from patients9 medical histories. The doxorubicin dose and the size of the particles were taken from the database of the centralised unit where cytostatics are made within the pharmacy department.

Results

12 patients (10 men) with an age average of 64 (44-81) (median=63) were included in the study. All patients were diagnosed with non-resectable MHC. 5 patients, (41.6%) got MHC as the result of alcoholic cirrhosis. In another 4 patients (33.3%) the MHC was produced secondarily after infection by VHC. 1 patient got the MHC directly from VHB infection, (8.3%). 2 patients (16.6%) were considered to have mixed MHC (viral- alcoholic). In 66.6% (8 patients) the treatment was started while they were awaiting a liver transplant, while in the other 4 cases it was used as palliative treatment. Patients were divided according to the Child-Pugh classification: 5 patients (41.6%) in group A, and 5 in group B (41.6%). It was impossible to determine the state of 2 patvients. According to the Okuda classification: 4 patients were in stage I (33.3%), 3 patients were in stage II (25%) and 1 patient in stage III (8.3%). In 4 patients, the classification could not be determined. As to the doses received: In 8 patients (66. 6%), maximum doses of 150 mg of doxorubicin were employed in particles of 100-300 µm and 300-500 µm. (Cost per cycle: 1266 €). In 4 patients (33.3%) 75 mg of doxorubicin was given in particles 100-300 µm. (Cost per cycle: 633.19€). The total number of HC was 13. In 25% of the cases, postembolisation syndrome appeared after the chemotherapy, but it was solved without complications.

Conclusions

The use of DCBP-D was adjusted to the right indication in all cases. The main risk factor associated with CHC was alcoholic cirrhosis. On the whole HC was well tolerated. Mild postembolisation syndrome was the only complication arising from treatment. The average cost of this treatment was 14559.57€.