没有标准的TACE方案，文献中TACE使用的药物非常多。比较不同技术的临床试验没有表现出哪一种更具优势。主要应用的药物包括铂类药物、阿霉素类药物和丝裂霉素C等。栓塞剂的使用主要包括常规TACE和药物洗脱微球的栓塞以及放射性微球栓塞。药物洗脱微球局部化疗和暂时性血管阻塞可以导致肿瘤局部区域：1. 较高的药物浓度和药物滞留，2. 少血管区域的血流再分配，3. 增加肝脏的摄取。这三点可以增加治疗的有效性和减少毒性，最终改善生活质量（QOL），增加存活率和由于降低副作用而获得病人最好的顺从性。 产品目前市场上的微球产品：
药物洗脱微球是肝动脉化疗性栓塞的新平台。
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| 水化（合）微球与药物荷载微球：将水化微球浸泡在伊立替康溶液中。发生离子交换的过程[1] |
伊立替康（300-500μm）荷载药物（50mg/ML) 镜下观[3]
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| 未荷载微球 | 7分钟 | 20分钟 |
DC-Bead是荷载和释放伊立替康药物的一个稳定系统，其稳定性超过28天[1]。微球直径经过精确校准，包括70-150μm、100-300μm和300-500μm大小的微球。通过离子交换荷载伊立替康50mg / 1cc 微球，100mg / 安瓶。在体外吸收药物 93% / 3小时，释放100% / 1周，荷载75%药物时间（t75%）为66分钟[2]。
实验动物模型表明，与静脉或动脉注射伊立替康比较，伊立替康载药微球动脉栓塞血清中伊立替康浓度较低，肿瘤内药物浓度较高和滞留时间较长，肿瘤最大坏死率在24小时左右[4]。
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| 静脉注射 = 25% | 动脉注射 = 60% | 伊立替康微球栓塞 = 95% |
I 期临床研究
II 期临床研究
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| 作者 | 病人数 | 治疗线 | 药物 | 栓塞剂 | 整体反应率 | PFS（月） | 中位生存期（月） |
| Alibertini（2006）[6] | 10 | TL | 伊立替康 | DC Bead | 75% | N.R. | 12 |
| Florentini（2007）[7] | 20 | TL | 伊立替康 | DC Bead | 65% | 6 | 14 |
| Alibertini（2011）[8] | 82 | STL | 伊立替康 | DC Bead | 78% | 8 | 25 |
| Martin（2012）[9] | 55 | STL | 伊立替康 | DC Bead | 75% | 11 | 19 |
Martin 等人报告55例一或二线化疗失败的结直肠癌肝转移患者进行共99伊立替康药物洗脱微球栓塞（30%的病人同时进行相似的化疗）。副反应发生率28%；无术后30天死亡。反应率在6个月为66%,12个月为75%，中位整体生存率为19个月[9]。
III 期临床研究
Florentini 等人对74例结直肠癌肝转移化疗抵抗的患者随机分为DEBIRI组（N=36，两次治疗）和FOLFIRI组（N=38，8次化疗）[10]。结果如下：
| DEBIRI(N=35) | FOLFIRI（N=35) | |
| CR+PR | 24（68.6%） | 7（20%) |
| SD | 4(11.4%) | 12(34.3%) |
| PD | 7(20%) | 16(45.7%) |
| 臂 | 平均中位生存期 | PFS | 急性毒性反应 | 后期毒性 | Edmonton 评分 |
欧元/人
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| DEBIRI(N=34） | 23 | 7 | 70% | 20% | 60% | 5000（2次） |
| FOLFIRI(N=35) | 15 | 4 | 25% | 80% | 22% | 18000（8次） |
Treatment Cost
• 6 months of biweekly 5-FU cost 975 €
• 6 months with FOLFOX/bevacizumab 100.000 €
• 6 months of FOLFIRI cost 35.000 €
• Drug-eluting beads preloaded with IRINOTECAN cost 10.000 €
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| 无进展生存期 | 整体生存率 |
| Giammaria Fiorentini et all ANNALS OF GASTROENTEROLOGY & HEPATOLOGY 2012; 3:(1). March 2012 | |
Mratin 等人报告10 例初始治疗的病人DEBIRI+FOLFOX全身化疗的结果。治疗后9-12个月反应率为100%（2CR，8PR）平均生存期为15.2月，40%的病人降期后得以肝切除或/和射频消融。结论：同时进行DEIRI栓塞和FOLFOX全身化疗用或不用贝伐单抗的结直肠癌肝转移患者安全和有效。副反应轻微，没有毒性限制剂量（dose-limiting toxicities），治疗反应率增加[11]。
可切除肝癌的新辅助治疗[12]
为什么（背景分析）？
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| 这么多年没什么进步，所以我们是否可以做到更好？ |
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| 新辅助化疗似乎效果好一些，但不尽人意 |
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| 新辅助化疗有效，反应越好生存期越长。肝肿瘤切除标本 | ||
既然可切除肝转移癌术前化疗，所谓新辅助化疗有效，在肝切除后继续化疗成为顺理成章的想法。
Nordlinger 等人[16]，对364例可切除肝转移癌进行随机分组，单纯外科切除组和外科切除前和术后化疗组。按RECIST标准CT评价术前化疗后结果显示
CR 7 （3.8%）
PR 73（40.1%）
SD 64（35.2%），8例在3-4次化疗后出现进展，其中3例切除；4例在6次化疗后出现进展，其中1例切除。
没有评价 26（14.3%）
肝切除后无进展生存期
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其它转移瘤的研究
| 作者/年 | 病例数/原发灶 | 治疗线 | 药物 | 栓塞剂 | 整体反应率% | PFS（月） | 中位生存率(月） |
| Florentini/2009[5] |
N=10 视网膜黑色素瘤 |
TL | 伊立替康 | DC Bead | 90 | 6.5 | 10 |
| Florentini/2012 |
N=52 视网膜黑色素瘤 |
STL | 伊立替康 | DC Bead | 83 | 7.5 | 13.9 |
| Fouad/2013 |
N=13 支气管肺癌 |
一线 |
阿霉素 伊立替康 |
DC Bead | 50 | 14 |
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