{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:46:53Z","timestamp":1791600413684,"version":"4.3.4"},"reference-count":30,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: The role of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) management has evolved over recent years. Although it appears that the overall number of procedures is declining, international guidelines now endorse TACE beyond the Barcelona Clinic Liver Cancer (BCLC) intermediate stage, and multiple TACE platforms allow patient-tailored treatments. In this context, degradable starch microspheres TACE (DSM-TACE) may be valuable when the goal is to preserve liver function and spare healthy parenchyma. This study reports multicenter retrospective Italian data to assess the efficacy and safety of DSM-TACE with EmboCept\u00ae in patients with early-to advanced-stage HCC, and to evaluate whether procedural selectivity (superselective vs. lobar) influences outcomes. Methods: This retrospective multicenter study included 201 patients initially; after applying exclusion criteria, 187 patients (334 HCC nodules) treated across eight centers (2014\u20132024) were analyzed. Treatment indications were discussed in multidisciplinary tumor boards in all centers. Superselective DSM-TACE was performed in 48 patients (66 nodules, 19.8%), while 139 patients (268 nodules, 80.2%) underwent a lobar approach. Repeated sessions were performed on demand and recorded for lobar treatments. Tumor response was assessed using mRECIST criteria at 1, 3\u20136, 6\u20139, and 9\u201312 months; adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE). efficacy and safety outcomes were compared according to the DSM-TACE approach. Results: In terms of safety, analysis confirmed the overall good tolerability of DSM-TACE, with no grade \u2265 3 adverse events and no major complications or procedure-related deaths. No significant differences were observed in post-embolization syndrome (PES) rates between groups. With regard to efficacy, for the entire cohort, the overall response rate (ORR) was 70% at 1 month, 31.6% at 3\u20136 months, 20.5% at 6\u20139 months, and 13.5% at 9\u201312 months, while the disease control rate (DCR) was 91.4% at 1 month, 69% at 3\u20136 months, 38.6% at 6\u20139 months, and 27% at 9\u201312 months. At intermediate follow-up, superselective DSM-TACE achieved higher ORR than lobar treatment at 3\u20136 months (53.8% vs. 26.4%; p = 0.009) and 6\u20139 months (43.8% vs. 15.3%; p = 0.009). Per-nodule analysis confirmed this advantage at 3\u20136 months (ORR = 66.7% vs. 31.3%; p = 0.0008). Conclusions: DSM-TACE with EmboCept\u00ae provides favorable tumor control and a good safety profile in routine clinical practice. A superselective approach is associated with improved response at intermediate follow-up compared with lobar strategy, supporting DSM-TACE as a flexible therapeutic option for localized HCC.<\/jats:p>","DOI":"10.3390\/cancers18050736","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T13:58:03Z","timestamp":1772114283000},"page":"736","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Retrospective Italian Registry on DSM-TACE: Experience Beyond Current Recommendations"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7448-1404","authenticated-orcid":false,"given":"Pierleone","family":"Lucatelli","sequence":"first","affiliation":[{"name":"Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Giulia","family":"Travaglini","sequence":"additional","affiliation":[{"name":"Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elio","family":"Damato","sequence":"additional","affiliation":[{"name":"Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy"},{"name":"PhD Program in Experimental and Clinical Hepato-Gastroenterology, Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Giurazza","sequence":"additional","affiliation":[{"name":"Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4160-8018","authenticated-orcid":false,"given":"Anna Maria","family":"Ierardi","sequence":"additional","affiliation":[{"name":"Radiology Department, Fondazione IRCCS C\u00e0 Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Luppi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Santa Chiara Hospital, APSS Trento, Largo Medaglie D\u2019Oro 9, 38122 Trento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Citone","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, Careggi Hospital, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Cianni","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, San Camillo Forlanini Hospital, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9567-6710","authenticated-orcid":false,"given":"Gianluca","family":"De Rubeis","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, San Camillo Forlanini Hospital, 00152 Rome, Italy"},{"name":"Department of Medical Imaging, University of Cagliari, 09042 Monserrato, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2737-2053","authenticated-orcid":false,"given":"Pierpaolo","family":"Biondetti","sequence":"additional","affiliation":[{"name":"Radiology Department, Fondazione IRCCS C\u00e0 Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2593-8148","authenticated-orcid":false,"given":"Fabio","family":"Corvino","sequence":"additional","affiliation":[{"name":"Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4226-4579","authenticated-orcid":false,"given":"Claudio","family":"Carrubba","sequence":"additional","affiliation":[{"name":"Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Vallati","sequence":"additional","affiliation":[{"name":"Interventional Radiology Oncology Unit, Deparment of Radiology and Diagnostic Imaging IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Cappelli","sequence":"additional","affiliation":[{"name":"Interventional Radiology Oncology Unit, Deparment of Radiology and Diagnostic Imaging IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9617-3413","authenticated-orcid":false,"given":"Alessandro","family":"Posa","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, Department of Diagnostic Imaging and Oncologic Radiotherapy, Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d\u2014IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6483-9912","authenticated-orcid":false,"given":"Marcello","family":"Lippi","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, Department of Diagnostic Imaging and Oncologic Radiotherapy, Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d\u2014IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Corona","sequence":"additional","affiliation":[{"name":"Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Panebianco","sequence":"additional","affiliation":[{"name":"Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4208-9691","authenticated-orcid":false,"given":"Carlo","family":"Catalano","sequence":"additional","affiliation":[{"name":"Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2791-481X","authenticated-orcid":false,"given":"Roberto","family":"Iezzi","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, Department of Diagnostic Imaging and Oncologic Radiotherapy, Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d\u2014IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"ref_1","unstructured":"European Association for the Study of the Liver (2025). 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