Epirubicin

The choice of conventional TACE or drug-eluting beads TACE was determined by consensus between interventional radiologists and hepatologists, and each patient was required to use the same chemoembolization agent throughout the study duration. Procedures were performed as previously recommended (27 (link)). Briefly, conventional trans arterial chemoembolization (cTACE) was performed with a maximum dose of 50 mg and 8 mL epirubicin and Lipiodol (Guerbet, Pairs, France), respectively. epirubicin was infused into the selective catheterization of the feeding artery as the chemotherapeutic agent. The feeding arteries were then embolized using an emulsion of epirubicin and iodized oil mixture, followed by an absorbable gelatin sponge (Gelpart: NipponKayaku, Tokyo, Japan). Drug-eluting transcatheter arterial chemoembolization (DEB-TACE) was performed with 100-300 μm DC beads (BTG, London, UK) loaded with 50 mg of epirubicin or 50-100 μm Hepasphere (Nippon-Kayaku, Tokyo, Japan) loaded with 50 mg of fine powder cisplatin (IA-call; Nippon-Kayaku). Embolization was performed until stasis in the tumor feeding vessels, preserving flow in the segmental and lobar arteries. Thereafter, TACE was repeated every 6-8 weeks at the discretion of the investigators.

All patients were examined by two interventional physicians (HTH and WLX). Epirubicin (Hisun, Zhejiang, China) and lipiodol (Lipiodol Ultrafluide, Laboratoire Guerbet, France) were injected into the blood vessels of the tumor according to the typical TACE protocol, and then gelatin sponge particles (Alicon Pharmaceutical Sci & Tec Co., Ltd., Hangzhou, China) were injected until the blood flow was largely blocked. The embolization therapy was ended when tumor staining disappeared. Additional treatments were based on the size and number of residual tumors, liver function, and patient performance status.