The dynamic complexity of liver tumour microperfusion can prove challenging for optimal embolisation, with the danger of treatment leading to only partial necrosis of the tumour. Tumor biology and DEB TACE better understanding have participated to improve embolic platforms as well as embolisation technique, in order to achieve deep targeted embolisation, predictable homogeneous tumour coverage and improved drug exposure supporting better tumour response. Early papers have shown that microspheres distribution centrally to the tumor is influencing embolisation effect and maximizing drug concentration to the tissues.
« Anoxia may lead to ischemic necrosis because deprivation of blood supply and oxygenation. HCC cell cultures may be completely dead only if anoxia lasts more than 24 hours »
Dr Franco Orsi, Italy
Tumour feeding vessels are estimated to be between 10 & 140 µm in size, with limited drug penetration into surrounding tissue (≤ 1 mm)
The use of 100-300 µm microspheres have demonstrated to be located within the periphery of the tumor.
Small sized and tightly calibrated microspheres below 100µm may lead to targeted embolisation with deeper tumour penetration.
“Small, standardised, precise calibrated spheres allowed for distal intratumoral occlusion, Bonomo et al “
The limited distance of the drug penetration limits the efficacy of the drug eluting implants.
A single large bead has the potential to contain a greater amount of drug than a small bead, HOWEVER, drug concentration is related to how many microspheres are inside the tumour.
The bigger the beads will be situated in the periphery of the tumour, thus releasing drug into the proximal feeding vessels
The use of 25-35 µm for radioembolisation, 40 µm for bland embolisation and vascular penetration measurements in preclinical studies, suggest that the lower limit for embolics maybe 25-50 µm.
Small beads take advantage of the arterial architecture of the tumour. This allows for a more spatially homogeneous and dense distribution of beads that may lead to greater drug coverage.
DID YOU KNOW?
Drug penetration into surrounding tissue is limited (≤ 1mm) and is one of the major restrictions on the efficacy of drug eluting implants.
Necrotic tissue might be associated with deep penetration & high concentration of the drug.
Beyond the occlusive effect of the embolic agent, the theoretical advantage of DEB TACE is to better control the amount and duration of drug delivery to the tumor.
For improved liver tumor response, Embozene TANDEM™ Microspheres are the only precisely calibrated microspheres which include small size options that enable to go deeper and
deliver more drug into the tumour to support maximum tumour necrosis.
For a predictable, consistent embolization, Embozene Microspheres provide a broad range of colored, precisely calibrated microspheres in prefilled syringes that enable controlled delivery and reduce potential catheter occlusion
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