According to BCLC staging system, HCC patients with well preserved liver function (Child Pugh A-B), portal vein tumor thrombosis or extrahepatic spread are classified as “advanced” or stage C and they present dismal prognosis. In these kind of patients and in those tumors progressing upon loco-regional therapies, the treatment of choice is represented by Sorafenib, an oral multikinase inihibitor that significant prolongs time to progression but without significant differences in time to symptomatic progression. In particular, about 80% of patients present adverse events (hand-foot syndrome, gastrointestinal symptoms) leading to permanent discontinuation in 11% of cases. In patients ineligible to or dismissing Sorafenib there is no available second-line therapy.

Based on this background, the aim of our study is to evaluate safety, feasibility and effectiveness of transarterial chemoembolisation with degradable-starch-microspheres (DSM-TACE), in the treatment of patients with advanced HCC dismissing or ineligible for multikinase-inhibitor chemotherapy administration (Sorafenib) due to unbearable side effects or clinical contraindications. 

DSM-TACE consists in degradable particles loaded with doxorubicin that allows the temporary occlusion of the smaller arterial vessels, improving the therapeutic effect (by reducing the immediate wash-out of the cytostatic agent) and decreasing the risk of systemic toxicity and post-embolic syndrome.