Abstract No. 221: Transarterial Chemoembolization of Metastatic Colorectal Carcinoma with Drug Eluting Beads: Multi-Institutional Study

HCC larger than 3 cm in diameter (range 3.3-7.0 cm; mean, 5.0 ⫾ 1.4) showing clear-cut evidence of residual viable tumor at CT or MR imaging obtained immediately after RFA were scheduled for DEB intraarterial administration. RFA was performed by using expandable multitined electrodes (RITA Medical Systems/AngioDynamics). Intraarterial DEB injection was performed within 24 hours of RFA: 50-125 mg doxorubicin were uploaded in either 100-300 or 300-500 m beads (DC Bead ®; Biocompatibles UK Ltd/ AngioDynamics). Tumor response was evaluated by CT and MR imaging at 1 month and at 3-month intervals during the follow-up (follow up range, 6-20 months; mean, 12 ⫾ 5; median 13). RESULTS: Treatment protocol was successfully completed in all patients. No major complication occurred. The range of volumes of coagulation necrosis increased from 15.4 128.9 cm3 (mean, 48.1 cm3 ⫾ 35.7) after RFA alone to 16.8 - 171.7 cm3 (mean, 75.5 cm3 ⫾ 52.4) after DEB administration, with an increase of 5-134% (mean, 60.9% ⫾ 39.0). At 1-month CT or MR imaging, complete response (CR) was shown in 14 (70%) of 20 patients, and partial response - with persistence of less than 10% of baseline tumor volume - was observed in 6 of 20. Two (14%) of 14 patients with CR developed local tumor progression during the follow-up. Four patients developed new HCC lesions, including two with CR. Sustained CR was therefore shown in 10 (50%) of 20 patients. At the time of the present analysis, 19 patients were alive and one patient was dead because of tumor progression. Overall 1-year survival by the KaplanMeier method was 100%. CONCLUSION: Intraarterial DEB administration substantially increases the effect of RFA in HCC. DEB-enhanced RFA did not cause any major complication and induced a high rate of sustained CR in tumors resistant to standard RFA treatment. 5:24 PM

Abstract No. 221

Transarterial Chemoembolization of Metastatic Colorectal Carcinoma with Drug Eluting Beads: Multi-Institutional Study. R.C.G. Martin,1 D. Tomalty,3 M. Samotowka,3 C. Tatum,1 K. Robbins;2 1University of Louisville & Norton Cancer Institute, Louisville, KY; 2Baptist Health, Little Rock, AR; 3 Huntsville Hospital, Huntsville, AL PURPOSE: To assess safety and efficacy of Irinotecan and Doxorubicin loaded beads (DC Bead™) delivered by transarterial embolization for the treatment of unresectable metastatic colorectal cancer (MCC). MATERIALS AND METHODS: This open-label, Multi-center, single arm study included 30 MCC patients, who had failed first line therapy. Patients received repeat embolizations with either Irinotecan loaded beads (max 100 mg per embolization) or Doxorubicin loaded beads (max 150 mg per embolization) pre treating physician’s discretion. Chemotherapy was loaded in DC Bead™ of 100-300 ␮m or 300-500 ␮m. RESULTS: All patients received planned dosing as either an outpatient or 23 hour observation. Bilirubin, ␥-GT, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) showed only transient increases observed during the study period. Irinotecan bead injection lead to a greater peri-procedural pain, which was effectively managed with pre-arterial lidocaine injection. There have been no adverse severe procedure-related comS84

plications. Post Embolization Syndrome (PES) was observed in only a small (15%) all patients. Combined systemic therapy with DC Bead™ was well tolerated, without any significant differences in peri-procedural laboratory values or tolerance to therapy. Overall, objective response using modified RECIST criteria was 75% at 3months, and 66% at 6 months. CONCLUSION: Chemoembolization using either Irinotecan or Doxorubicin loaded DC Bead™ was safe and effective in the treatment of MCC as demonstrated by a minimal complication rate, acceptable tumor response and sustained reduction of CEA levels. Further larger studies are needed to confirm this data, and establish where hepatic arterial precision chemotherapy should be utilized in the algorithm of the metastatic colorectal cancer patient. 5:36 PM

Abstract No. 222

Chemoembolization Using Drug-Eluting Beads for Metastatic Carcinoid Disease. J.L. Friese,1 C.A. Binkert,2 M. Kulke;1 1Brigham & Women’s Hospital, Boston, MA; 2Kantonsspital, Winterthur, Switzerland PURPOSE: Trans-arterial hepatic bland embolization (TAE) and/or chemoembolization (TACE) are established palliative treatment for metastatic carcinoid with approximate response rates ranging from 45 to 70 percent. The purpose of this retrospective study was to describe a single institution’s experience with drug-eluting beads, specifically highlighting technical efficacy and medium-term radiologic follow-up. MATERIALS AND METHODS: All patients treated at Brigham & Women’s Hospital with doxorubicin-impregnated drug-eluting beads (DEB) for metastatic carcinoid to the liver were included in this retrospective study. Angiographic, radiographic and clinical data were retrieved from the electronic medical record. Pre-procedure, immediate post-procedure, and subsequent follow-up CT and/or MRI imaging was evaluated by a board-certified radiologist using EASL and RECIST criteria. RESULTS: 19 patients underwent 36 procedures between 12/2005 and 1/2007. 100 percent technical success was achieved using 100-300 ␮m (n⫽16) and 300-500 ␮m (n⫽20) beads. 1 major complication occurred (perfusion defect and biliary obstruction requiring stent placement). Average length-of-stay was 1.1 day. Short-term (⬃ 3 month) follow-up imaging showed objective response in 26 (72%) when combining RECIST and EASL criteria, with stable disease in the remaining 10 (28%). Medium-term follow-up imaging (mean 49 weeks, range 18-70) was available in 15 patients. Persistent objective response was noted in 8 (53%) with progressive disease in 4 (27%). CONCLUSION: Transarterial therapy with drug-eluting beads appears to be well tolerated and produces short and medium-term results that compare favorably with existing TACE regimens for carcinoid hepatic metastases. Follow-up Short-term (RECIST) Short-term (EASL) Medium-term (RECIST) Medium-term (EASL)

Complete Response 2

Partial Response 13

Stable Disease 21

Progressive Disease 0

9 1

16 7

11 3

0 4

1

6

4

4