European Radiology

, Volume 29, Issue 3, pp 1285–1292 | Cite as

TACE with degradable starch microspheres (DSM-TACE) as second-line treatment in HCC patients dismissing or ineligible for sorafenib

  • Roberto IezziEmail author
  • Maurizio Pompili
  • Emanuele Rinninella
  • Eleonora Annicchiarico
  • Matteo Garcovich
  • Lucia Cerrito
  • Francesca Ponziani
  • AnnaMaria De Gaetano
  • Massimo Siciliano
  • Michele Basso
  • Maria Assunta Zocco
  • GianLodovico Rapaccini
  • Alessandro Posa
  • Francesca Carchesio
  • Marco Biolato
  • Felice Giuliante
  • Antonio Gasbarrini
  • Riccardo Manfredi
  • the HepatoCatt Study Group



To date, there is no approved second-line treatment for patients dismissing sorafenib or ineligible for this treatment, so it would be useful to find an effective alternative treatment option. The aim of our study was to evaluate safety, feasibility and effectiveness of transarterial chemoembolisation with degradable starch microspheres (DSM-TACE) in the treatment of patients with advanced hepatocellular carcinoma (HCC) dismissing or ineligible for multikinase-inhibitor chemotherapy administration (sorafenib) due to unbearable side effects or clinical contraindications.


Forty consecutive BCLC stage B or C patients (31 male; age, 70.6 ± 13.6 years), with intermediate or locally advanced HCC dismissing or ineligible for sorafenib administration, who underwent DSM-TACE treatment cycle via lobar approach were prospectively enrolled. Tumour response was evaluated on multidetector computed tomography based on mRECIST criteria. Primary endpoints were safety, tolerance and overall disease control (ODC); secondary endpoints were progression-free survival (PFS) and overall survival (OS).


Technical success was achieved in all patients. No intra/peri-procedural death/major complications occurred. No signs of liver failure or systemic toxicity were detected. At 1-year follow-up, ODC of 52.5% was registered. PFS was 6.4 months with a median OS of 11.3 months.


DSM-TACE is safe and effective as a second-line treatment in HCC patients dismissing or ineligible for sorafenib.

Key Points

DSM-TACE is safe and effective as second-line treatment in HCC patients dismissing or ineligible for sorafenib

DSM-TACE allows the temporary occlusion of the smaller arterial vessels, improving overall therapeutic effectiveness by reducing the immediate wash-out of the cytostatic agent

DSM-TACE also decreases the risk of systemic toxicity and post-embolic syndrome


Hepatocellular carcinoma Chemoembolisation Therapeutic Sorafenib Precision medicine 



Barcelona Clinic Liver Cancer stage B


Barcelona Clinic Liver Cancer stage C


Complete response


Degradable starch microspheres – transarterial chemoembolisation


Eastern Cooperative Oncology Group


Hepatocellular carcinoma


Japan Society of Hepatology


Overall disease control


Overall response rate


Overall survival


Progression free survival


Partial response


Stable disease


Selective internal radiotherapy



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Roberto Iezzi, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.


• prospective

• experimental

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Roberto Iezzi
    • 1
    Email author
  • Maurizio Pompili
    • 2
  • Emanuele Rinninella
    • 2
  • Eleonora Annicchiarico
    • 2
  • Matteo Garcovich
    • 2
  • Lucia Cerrito
    • 2
  • Francesca Ponziani
    • 2
  • AnnaMaria De Gaetano
    • 1
  • Massimo Siciliano
    • 2
  • Michele Basso
    • 3
  • Maria Assunta Zocco
    • 2
  • GianLodovico Rapaccini
    • 2
  • Alessandro Posa
    • 1
  • Francesca Carchesio
    • 1
  • Marco Biolato
    • 2
  • Felice Giuliante
    • 4
  • Antonio Gasbarrini
    • 2
  • Riccardo Manfredi
    • 1
  • the HepatoCatt Study Group
  1. 1.Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli - IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
  2. 2.Dipartimento di Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli - IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
  3. 3.Dipartimento di Oncologia, Fondazione Policlinico Universitario A. Gemelli - IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
  4. 4.Dipartimento di Chirurgia, Fondazione Policlinico Universitario A. Gemelli - IRCCSUniversità Cattolica del Sacro CuoreRomeItaly

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