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Retrospective Italian Registry on DSM-TACE: Experience Beyond Current Recommendations.

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Degradable starch microspheres transarterial chemoembolization (DSM-TACE) with EmboCept® is safe and effective for hepatocellular carcinoma (HCC). A superselective approach shows improved tumor response compared to lobar treatment, highlighting DSM-TACE's flexibility.

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Area of Science:

  • Interventional Radiology
  • Hepatobiliary Oncology
  • Oncology

Background:

  • Transarterial chemoembolization (TACE) plays an evolving role in hepatocellular carcinoma (HCC) management, with guidelines expanding its use beyond intermediate stages.
  • Degradable starch microspheres TACE (DSM-TACE) offers a potential advantage in preserving liver function and healthy tissue.
  • This study evaluates the efficacy and safety of DSM-TACE using EmboCept® in HCC patients and compares superselective versus lobar procedural approaches.

Purpose of the Study:

  • To assess the efficacy and safety of DSM-TACE with EmboCept® in a multicenter cohort of HCC patients.
  • To compare outcomes between superselective and lobar DSM-TACE approaches.
  • To evaluate the impact of procedural selectivity on tumor response and safety.

Main Methods:

  • Retrospective multicenter analysis of 187 HCC patients (334 nodules) treated between 2014-2024.
  • Patients received either superselective (19.8%) or lobar (80.2%) DSM-TACE.
  • Tumor response assessed by mRECIST criteria; adverse events by CTCAE. Outcomes compared between procedural approaches.

Main Results:

  • DSM-TACE demonstrated good tolerability with no grade ≥ 3 adverse events or procedure-related deaths.
  • Overall response rate (ORR) was 70% at 1 month, decreasing over time; disease control rate (DCR) was 91.4% at 1 month.
  • Superselective DSM-TACE showed significantly higher ORR at 3-6 months (53.8% vs. 26.4%) and 6-9 months (43.8% vs. 15.3%) compared to lobar approach.

Conclusions:

  • DSM-TACE with EmboCept® is a safe and effective treatment option for HCC in routine clinical practice.
  • The superselective approach is associated with improved intermediate tumor response compared to the lobar strategy.
  • DSM-TACE offers a flexible therapeutic option for localized HCC, with procedural selectivity influencing outcomes.