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Small versus large-sized drug-eluting beads (DEBIRI) for the treatment of hepatic colorectal metastases: a propensity score matching analysis.

AbstractPURPOSE:
To compare the feasibility, safety, and efficacy with small and large irinotecan drug-eluting beads (DEBIRI) for treating hepatic colorectal metastases.
METHODS:
Using our prospectively maintained, multi-center, intra-arterial therapy registry, we identified 196 patients treated with a combination of large beads (100-300 to 500-700 μm) and patients treated with a combination of small beads (70-150 to 100-300 μm). To minimize selection bias, a propensity score analysis was performed to compare both groups.
RESULTS:
Unadjusted analysis consisted of 196 and 30 patients treated with large and small beads, respectively. The adjusted analysis consisted of 19 patients each. Unadjusted analysis showed decreased all-grade (p = <0.001) and high-grade adverse effects (p = 0.02) in the small bead group, with a persisting trend toward decreased overall side effects in the adjusted analysis favoring small beads (p = 0.09) The adjusted analysis showed the percentage dose delivered (delivered dose/intended dose) was significantly greater in the small bead group compared to the large bead group (96 vs 79 %; p = 0.005). There were also a lower percentage of treatments terminating in complete stasis in the adjusted analysis (0.0035). Adjusted analysis also showed increased objective response rate (ORR) at 12 months (p = 0.04), with a corresponding trend also seen in the unadjusted analysis (0.09).
CONCLUSION:
Smaller beads result in increased dose delivery probably due to less propensity to reach complete stasis. It may also lead to more durable long-term efficacy. Smaller beads also demonstrate similarly low toxicity compared to large-sized beads with a trend toward less toxicity.
AuthorsOlaguoke K Akinwande, Prejesh Philips, Petr Duras, Stefan Pluntke, Charles Scoggins, Robert C G Martin
JournalCardiovascular and interventional radiology (Cardiovasc Intervent Radiol) Vol. 38 Issue 2 Pg. 361-71 (Apr 2015) ISSN: 1432-086X [Electronic] United States
PMID25366090 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
Chemical References
  • Drug Carriers
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Chemoembolization, Therapeutic
  • Colorectal Neoplasms (pathology)
  • Drug Carriers (therapeutic use)
  • Feasibility Studies
  • Female
  • Humans
  • Liver (radiography)
  • Liver Neoplasms (radiography, secondary, therapy)
  • Male
  • Middle Aged
  • Propensity Score
  • Prospective Studies
  • Tomography, X-Ray Computed
  • Treatment Outcome

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