The aim of our study was to identify an analgesic protocol which do not provide deep sedation and it is able to control transarterial chemoembolization (TACE) induced pain, with drug-eluting beads loaded with irinotecan (DEBIRITM). The efficacy of the protocol was evaluated according to the number of patients who subsequently underwent one or two additional treatment courses.

Between February 2009 and July 2013, 87 patients (47 male and 39 female aged 54 to 79 years) with colorectal liver metastases, not treatable by surgery, were treated with the FOLFOX and FOLFIRI chemotherapy regimens. Patients who did not respond to chemotherapy and who were eligible to third-line therapy were treated locally with Irinotecan-loaded Drug-eluting Beads (DEBIRI®). This technique consists of the intrahepatic embolization of metastases with non-absorbable 75-150 micron beads (DCBeads- Biocompatibles UK Ltd)) pre-loaded with 200 mg of irinotecan. The periprocedural medications adopted...

Our study includes 87 patients treated with DEBIRI and the modified analgesic protocol; 15 patients (14%) were free of pain after treatment, 18 (21%) required an additional dose of morphine on the way back to the clinical department, observing a pain control in the 2 hours after the procedure. The remaining 54 patients (56%) had a post-embolization syndrome characterized by pain and nausea, adequately mitigated by the new drug protocol. In these 54 patients we observed: pain in the right upper quadrant (83%), fever (10%),...

This new analgesic protocol remarkably reduced the post-embolization syndrome, thus allowing repeated DEBIRI treatments that helped to lengthen the medium-term survival of patients.

Department of Diagnostic and Interventional Radiology, S.Pertini Hospital - Rome

1. First human study in treatment of unresectable liver metastases from colorectal cancer with irinotecan-loaded beads (DEBIRI). Eichler K, Zangos S, Mack MG, Hammerstingl R, Gruber-Rouh T, Gallus C, Vogl TJ. Int J Oncol. 2012 Jul 25. doi: 10.3892/ijo.2012.1572. 2. Trans-arterial chemoembolization of metastatic colorectal carcinoma to the liver adopting DC Bead®, drug-eluting bead loaded with irinotecan: results of a phase II clinical study. Aliberti C, Fiorentini G, Muzzio PC, Pomerri F, Tilli M, Dallara S, Benea G. Anticancer Res. 2011 Dec;31(12):4581-7. 3. Transarterial chemoembolisation...