2CASE STUDY DC Bead LUMI™

LUMI-TACE of Small Infiltrative HCC

Antonio Federico Nicolini, MDFondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy

PRESENTATION• 80-year-old male: – Hepatitis C – Cirrhosis• Single 2.6cm hypervascular lesion with infiltrative characteristics

identified in segment VIII on quadriphasic CT study (HCC) A

• Child Pugh A5

Presentation: HCC diagnosis confirmed by quadriphasic contrast-enhanced CT study showing 2.6cm hypervascular lesion in segment VIII in axial (top) and coronal (bottom) planes

A

TREATMENT• A single LUMI-TACE procedure was peformed: – One vial (2ml) DC Bead LUMI™ loaded with 75mg doxorubicin

was mixed with 40ml contrast medium – Angiographic study of celiac artery and right hepatic artery

showed a slight hypervascular lesion B – Microcatheterisation with 2.0Fr catheter of sub-segmental

vessels in segment VIII C

– DC Bead LUMI™ 70-150µm loaded with 75mg doxorubicin were administered at a controlled rate using a 1ml syringe

– Administration continued until complete stasis was reached (1/8 vial used) D

One of the most interesting aspects of LUMI-TACE is the ability to evaluate, after the treatment, previously unidentified vessels that supply blood to the nodule.

LUMI-TACE: Selective catheterisation LUMI-TACE: Super-selective catheterisation LUMI-TACE: Angiographic control after delivery of DC Bead LUMI™. The nodule is not visible

B C D

2CASE STUDY DC Bead LUMI™

DC Bead LUMI™ are manufactured by Biocompatibles UK Ltd, Chapman House, Farnham Business Park, Weydon Lane, Farnham, Surrey, GU9 8QL, UK. Biocompatibles UK Ltd is a BTG International group company. DC Bead LUMI is a trademark of Biocompatibles UK Ltd. ‘Imagine where we can go’ and ‘See More. Treat Smarter.’ are trademarks and BTG and the BTG roundel logo are registered trademarks of BTG International Ltd. © 2017 Biocompatibles UK Ltd. EM-LUM-2017-0545. Date of preparation September 2017.

OUTCOME• Non-contrast CT performed one hour after LUMI-TACE showed

complete opacification of the peri-nodular vessels and partial opacification of the nodule itself E

• At one-month follow-up: – Non-contrast CT shows no opacification of the nodule and

unchanged opacification of the peri-nodular vessels F

– Contrast-enhanced CT shows subtotal necrosis of the treated lesion with tumour growth on the medial side G

– Fusion image reveals previously unidentified anterior vessel supplying the residual nodule H

• No adverse events• No change in laboratory parameters or Child Pugh status

CONCLUSION• One of the most interesting aspects of LUMI-TACE is the ability to

evaluate, after the treatment, previously unidentified vessels that supply blood to the nodule

• In this case, the contrast-enhanced CT scan clearly showed a small vessel that had not been embolised

CT: Computed tomographyHCC: Hepatocellular carcinoma

One month post LUMI-TACE: Contrast-enhanced CT shows subtotal necrosis of the treated lesion but tumour growth on the medial side

One month post LUMI-TACE: Contrast-enhanced CT (fusion image) shows unembolised anterior vessel that is supplying the residual nodule

F

G

H

LUMI-TACE of Small Infiltrative HCC

Antonio Federico Nicolini, MDFondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy

One hour post LUMI-TACE: Non-contrast CT shows partial opacification of the nodule and complete opacification of the peri-nodular vessels

E

DC Bead LUMI™

Red & yellow = DC Bead LUMI™

Residual nodule

Untreated vessel

Vessel treated with LUMI- TACE

One month post LUMI-TACE: On non-contrast CT, there is no opacification of the nodule and unchanged opacification of the peri-nodular vessels

SEE MORE. TREAT SMARTER.