Table 4. Summary of Technique.

Preparatory imaging

Tri-phasic dynamic CT or MRI

Periprocedural medication

Analgesics

Antibiotics for patients with increased risk of infection

Loading of chemotherapeutic drug

Microspheres are mixed with chemotherapeutic drug for at least 2 hours

After loading, 5–10 mL of nonionic contrast should be per 1 mL of DC Bead® (BTG)

Doses of chemotherapeutic drugs

Each single treatment for patients within Milan criteria consists of 50–75 mg of doxorubicin loaded into one vial containing 2 mL of microspheres

Each single treatment for patients who exceed Milan criteria consists of up to 150 mg of doxorubicin loaded into two vials of microspheres

Treatment of patients with large tumors or tumors involving both lobes usually requires two separate sessions 2–4 weeks apart

Super-selection of HCC tumors

Following initial diagnostic visceral arteriography of superior mesenteric artery, celiac trunk, and common hepatic artery, vascular anatomy, possible feeding arteries and any variants are assessed, as are portal vein status

Microsphere injection

Proper positioning of microcatheter in which it should not be wedged

Microspheres are injected slowly until endpoint near stasis is attained

If endpoint near stasis is not reached after complete injection of all loaded microspheres, another session should be scheduled to repeat treatment

Follow-up and repeat procedures

CT or MRI is done at 1, 3, and 6 months after procedure and at 3 month intervals thereafter

If viable tumors are observed, repeated cycles of DEM-TACE are recommended at 2–3-month intervals

Criteria for stopping treatment include disease progression, failure to achieve targeted objective response, patient deterioration, and persistent hepatic decompensation

CT = computed tomography, MRI = magnetic resonance imaging