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Management of Diffuse Hepatocellular Carcinoma (≧ 10 Lesions) with Doxorubicin-Loaded DC Beads Is a Safe and Effective Treatment Option

Background: Multinodular hepatocellular carcinoma (HCC; ≧ 10 lesions) has been considered a controversial indication for transarterial chemoembolization (TACE) based on the extent of disease and the belief that no clinical benefit can be achieved. The aim of this study was to assess the safety and efficacy of chemoembolization with doxorubicin-eluting beads (DEBDOX) in the treatment of multinodular HCC. Patients and Methods: A 503-patient prospective multinational DC Bead registry database from 6/2007 to 2/2010 identified 176 patients treated for HCC with DEBDOX. Results: There were 42 patients with multinodular HCC compared to 134 with non-multinodular HCC. After a median follow-up of 12 months, the multinodular group response rate according to modified RECIST criteria was 56% and median overall survival was 7.6 months, compared to 57% and 15 months in the non-multinodular group (p = 0.08). Conclusions: Multinodular HCC represents a more advanced stage of disease; however, DEBDOX treatment is safe and effective when compared to historical controls and current best systemic therapy. Continued hepatic arterial therapy and evaluation is needed in this clinical subset to further confirm these results.