Comparative study between Embosphere® and Marine gel® as embolic agents for chemoembolization of hepatocellular carcinoma

ARTICLE HIGHLIGHTS

Research background

Hand-cut or crushed gelatin sponge particles have been used in Asian countries for decades as embolic materials in conventional transarterial chemoembolization (cTACE), but they have limitations, including a wide range of sizes and a tendency to aggregate, which can reduce treatment efficacy. In Western countries, microspheres like Embosphere^® are preferred due to their ability to penetrate fine intratumoral vessels and their predictable size. The choice between these embolic agents, with gelatin sponge particles being temporary and Embosphere^® being permanent, can impact the duration and effectiveness of the cTACE treatment, although direct comparisons between them are rare.

Research motivation

Lately, there has been an introduction of calibrated gelatin sponge particles derived from fish, marketed under the name Marine gel^® (PL Micromed, Yangsan, Korea), which are being considered as a possible alternative. These particles are anticipated to provide the advantages of both temporary embolic materials and calibrated microspheres.

Research objectives

The aim of this study was to evaluate the effectiveness and safety of superselective cTACE when utilizing either Embosphere^® or Marine gel^® as the embolic agent in individuals with early-stage hepatocellular carcinoma (HCC).

Research methods

This retrospective analysis involved 70 patients diagnosed with small HCC, measuring less than 4 cm in size. These patients underwent chemoembolization procedures at a single medical center between March 2021 and July 2022, with Embosphere^® (n = 33) or Marine gel^® (n = 37) serving as the chosen embolic agents. The study involved a comprehensive review of radiological images and clinical data, focusing on factors such as tumor response, complications associated with the procedure, and instances of local tumor recurrence. The effectiveness of the primary index tumor treatment was assessed using a 1-mo follow-up imaging analysis. The study also calculated local progression-free survival using the Kaplan-Meier method and compared the outcomes using the log-rank test.

Research results

Both groups had a median tumor size of 1.5 cm, and after one month of undergoing cTACE, 69 patients achieved a complete response. The cumulative local recurrence rate at the 12-mo mark was 15.5% in the Embosphere^® group and 14.4% in the Marine gel^® group. Notably, there was no significant difference in local progression-free survival between these two groups (P = 0.83). In a multivariate analysis, high serum alpha-fetoprotein emerged as the sole significant adverse prognostic factor for local tumor progression (P = 0.01).

Research conclusions

Superselective cTACE for small HCC yields comparable tumor response outcomes when employing calibrated gelatin sponge particles (Marine gel^®) and calibrated microspheres (Embosphere^®).

Research perspectives

Multicenter prospective study is needed to confirm the adequate embolic agents in chemoembolization for HCC.