الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma is the most frequent primary tumor of
the liver, the incidence of which is increasing worldwide. Cirrhosis of the
liver, regardless of etiology, is considered to be the main risk factor for
the onset of HCC. Hepatitis C and B virus are the main factor related to
the presence of cirrhosis of the liver in patients with hepatocellular carcinoma. Trans arterial chemoembolisation (TACE) is the most widely
used treatment for hepatocellular carcinoma in non surgical patients notsuitable for radiofrequency ablation .
To best assess the prognosis of hepatocellular carcinoma patients
it is recommended that the staging system takes into account tumor stage,
liver function and physical status. Currently, the BCLC system is the only
staging system that accomplishes this aim. Patients who have intermediate-stage hepatocellular carcinoma according to the BCLC staging system are the optimal candidates for transcatheter arterial chemoembolization as a palliative treatment. Palliative options should
aim to improve survival without greatly impairing the quality of life.
In conventional TACE therapy, tumor selectivity is achieved when chemotherapeutic agents are mixed with lipidol , to induce ischemia in tumors. In addition, there are side effects of Lipidol as it penetrates the portal venules and hepatic sinusoids and affects the hepatic microcirculation, also doxorubicin is lost from lipidol in a very short period of time.
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Summary and Conclusion
DC Bead microspheres are a new embolic material for TACE, in
which the embolization particles are made from a unique drug –eluting
bead (DEB) technology based on polyvinyl alcohol (PVA) hydrogel that
has been modified with sulphonate groups. They can be loaded with a
chemotherapeutic agent widely accepted for treatment of HCC.
The advantage of using it is sustained release of chemotherapeutic
agent over a long period of time, which contrasts with the more rapid
release of the agents from the lipidol solution in standard TACE therapy.
With a controlled gradual and local release, contact time of the drugs with
the tumor is greater and plasma levels of the drugs are lower than those with standard TACE therapy, also less side effects and doubling the dose
using 150 mg instead of 70 -100 mg using lipidol.
Good results are generally observed when a reduced number of
not very large tumors are embolized in a selective fashion (ideally through a distinct feeding vessel). from a mechanistic point of view, DEB are a much more reasonable and reproducible way to perform TACE. In fact, the two particles available are claimed to turn TACE into
a feasible and well-tolerated procedure associated with a low complication rate and a promising tumor response rate.
Secondary endpoints, including reduction in drug-related adverse
events or increased intra tumoral necrosis (which makes the difference
between RECIST and EASL criteria), have been proven successful and
are consistent with the well-known characteristics of the beads as shown
in preclinical work. The potential advantage of DEB-TACE over conventional TACE in the subgroup of patients with the worst prognosis
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Summary and Conclusion
(Child-Pugh B, ECOG 1, bi lobar or recurrent disease, Okuda stage I tumor and CLIP score _3) should be treated with caution because it comes from the analysis of a very small group of patients and it is generally recognized that TACE should be indicated very in this subgroup of patients who have a poor prognosis for which a survival advantage has not been shown after conventional TACE, The safety profiles of the two modalities of treatment appear similar.
Authors of a recent prospective randomized comparison (Malagari et al .,2010 ) of chemoembolization with doxorubicin eluting beads and arterial embolization with Bead Block (Biocompatibles, UK) for HCC concluded that although ischemia plays a role in the development of tumor necrosis, there is a clear additional benefit from the addition of doxorubicin. In that study, there was a complete response in 26.8% of patients in the drug-eluting bead group and 14% in the arterial embolization group at 6 months.
The results of our study showed the efficacy and safety of using DC beads concerning :
A. Effect of DC beads on liver functions .
B. Effect of DC beads on AFP level .
C. The response of the tumor after DC beads .
D. Effect of DC beads on survival rate.
E. Complications of using DC beads in TACE
This suggested high evidence of efficacy doxorubicin-loaded DC beads in treating patient with unresectable HCC in the form of good tumor response showed in the study evaluated by mRECIST criteria , high percentage of tumor necrosis occurred after the treatment and significant decrease of AFP levels .
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Summary and Conclusion
Also this study the safety of using drug eluting beads in treatment of unresectable HCC in the form of low rate of treatment- related complications , with good results of overall survival and disease free survival .
In conclusion, this study suggests of high evidence of efficacy and safety of doxorubicin-loaded DC beads in treating patient with unresectable HCC.