Callispheres

TACE was carried out using a micro-puncture system via placing a 5F vascular introducer (Boston Scientific, USA) through a transfemoral arterial access route. Angiography of the hepatic artery was executed to provide the liver’s vascular anatomy. The CalliSpheres^® (Jiangsu Hengrui Medicine Co, Ltd., China) DEB loading was performed as follows: after the injection of CBs to the chemotherapy reagent solution was performed, the mixed solution was shaken up every 5 minutes for 30 minutes in an injector at a temperature of 23–28 °C. After that, adding non-ionic contrast agent into the same injector was performed at the ratio of (1–1.2):1 compared to the mixed solution and placed for 5 minutes at a temperature of 23–28 °C for use. Two mL 100–300 µm CalliSpheres^® DEBs (Jiangsu Hengrui Medicine Co, Ltd., China) loaded with 50–80 mg of anthracyclines (doxorubicin) for metastatic lung cancer and breast cancer patients, and 100–200 mg irinotecan for intestinal cancer, gastric cancer, and pancreatic cancer patients, were used and administered until stasis in each patient. After the procedure, patients were admitted and monitored to the hospital overnight.

The initial TACE treatment should be performed within 30 days before or after systemic treatment. Since no significant difference in efficacy between conventional TACE and drug-eluting beads-TACE (DEB-TACE) has been reported,16 (link),17 (link) specific method was chosen by experienced interventional radiologists based on tumor burden, macrovascular invasion, liver function, and patient tolerance from either (1) DEB-TACE: Epirubicin was loaded into 100–300 μm or 300–500 μm HepaSphere (Merit Medical, USA) or CalliSpheres (Jiangsu Hengrui Medicine Co., Ltd., Jiangsu, China) microspheres; or (2) Conventional TACE: Ethiodized oil (Jiangsu Hengrui Medicine Co., Ltd., Jiangsu, China) and epirubicin were thoroughly mixed into a lipiodol emulsion in a ratio of 2:1. Gelatin sponge particle was used for embolization in either case. The tumor feeding artery was catheterized super-selectively, and the chemoembolization agents were injected until the tumor feeding artery was completely embolized. Lenvatinib was suspended 1–3 days before and after TACE, and then resumed to original level once liver function has recovered. Atezolizumab/Bevacizumab was administered according to the treatment schedule without being affected by TACE.

All procedures were conducted using the GE3100 DSA system. Before the procedure, doxorubicin in the range of 60–80mg was loaded onto drug-eluting beads (CalliSpheres, Jiangsu Hengrui Medicine Co. Ltd., China). The size of the beads, ranging from 100–300 or 300–500µm, was selected based on the tumor diameter and blood supply characteristics. Initially, diagnostic angiographies were performed using a 4F RH catheter to gather all pertinent tumor information, including location, diameter, and feeding arteries. Subsequently, a microcatheter was advanced in a superselective manner into the feeding artery. The drug-eluting beads were then slowly injected into the vessel under fluoroscopy. Upon reaching the intended endpoint, a follow-up angiography was performed to assess the effectiveness of embolization.