SPECIAL COMMUNICATION Transarterial Treatment of Colorectal Cancer Liver Metastases with Irinotecan-Loaded Drug-Eluting Beads: Technical Recommendations Riccardo Lencioni, MD, Camillo Aliberti, MD, Thierry de Baere, MD, Ricardo Garcia-Monaco, MD, Govindarajan Narayanan, MD, Elizabeth O’Grady, MD, William S. Rilling, MD, Duncan Walker, MD, and Robert C.G. Martin, MD ABSTRACT Transcatheter hepatic arterial administration of irinotecan-loaded drug-eluting beads (DEBIRI) is used to treat liver-only or liver-dominant metastatic disease from colorectal cancer (CRC). Eligibility for DEBIRI should be established in each individual patient by a multidisciplinary team based on comprehensive clinical, imaging, and laboratory assessment. Standardization of DEBIRI technique and protocols would be expected to lead to improved efficacy and safety. The present article provides a set of technical recommendations for the use of DEBIRI in the treatment of hepatic CRC metastases. ABBREVIATIONS CRC = colorectal cancer, DEBIRI = irinotecan-loaded drug-eluting bead Colorectal cancer (CRC) is the third most common malignancy in men and the second in women, affecting more than 1.2 million people per year worldwide (1). The development of metastases is the main cause of death in patients with CRC. Surgical resection is the first-line treatment for hepatic CRC metastases (2,3). Unfortunately, despite the progress of modern surgical techniques, radical resection is possible only in 10%– 25% of patients with CRC metastases confined to the liver (4). Several interventional locoregional treatments, including—among others—transcatheter hepatic arterial administration of drug-eluting beads or yttrium-90 ( 90 Y) radioactive microspheres, have been used in patients with unresectable liver-only or liver-dominant metastatic disease (5,6). In particular, studies have suggested that transarte- rial injection of irinotecan-loaded drug-eluting beads (DEBIRI) may offer a novel approach to locoregional hepatic chemotherapy. Pharmacokinetic analyses have shown the bioavailability from DC Bead (Biocompatibles UK, Farnham, United Kingdom)–based delivery of irinotecan is double that of intravenous infusion, attrib- utable to reduced drug clearance for the former (7). Experimental animal studies (8) have confirmed that DEBIRI induces lower early serum levels of irinotecan, a high and prolonged intratumoral level of irinotecan, and a greater rate of tumor necrosis compared with intraarterial or intravenous injection of irinotecan. Pilot clinical trials have suggested that DEBIRI treatment— administered in combination with systemic 5-fluorouracil & SIR, 2014 J Vasc Interv Radiol 2014; 25:365–369 http://dx.doi.org/10.1016/j.jvir.2013.11.027 R.G.-M. and G.N. are consultants for Biocompatibles UK (Farnham, United Kingdom). W.S.R. is a consultant for Cook (Bloomington, Indiana), B. Braun (Bethlehem, Pennsylvania), and AngioDynamics (Latham, New York), and receives research support from Nordion (Ottawa, Ontario, Canada), Sirtex (North Sydney, Australia), Biocompatibles UK, and B. Braun. None of the other authors have identified a conflict of interest. From the Division of Diagnostic Imaging and Intervention (R.L.), Pisa University School of Medicine, Pisa; Interventional Oncology Unit (C.A.), Istituto Oncologico Veneto, Padua, Italy; Department of Interventional Radi- ology (T.d.B.), Institut Gustav Roussy, Villejuif, France; Department of Radi- ology (R.G.-M.), Hospital Italiano, Universidad de Buenos Aires, Buenos Aires, Argentina; Division of Vascular Interventional Radiology (G.N.), University of Miami Miller School of Medicine, Miami, Florida; Division of Vascular and Interventional Radiology (W.S.R.), Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Surgical Oncology (R.C.G.M.), University of Louisville, Louisville, Kentucky; Department of Radiology (E.O.), University Hospital Aintree, Liverpool, United Kingdom; and Department of Radiology (D.W.), Wesley Hospital, Auchenflower, Australia. Received June 24, 2013; final revision received November 18, 2013; accepted November 24, 2013. Address correspondence to R.L., Division of Diagnostic Imaging and Intervention, Pisa University School of Medicine, Cisanello Hospital, Building 29, Via Paradisa 2, Pisa 56124, Italy; E-mail: riccardo.lencioni@med.unipi.it