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Research Article
9 April 2026

Clinical outcomes of pressure-enabled drug delivery for trans-arterial chemoembolization and radioembolization

Authors: Deepshekhar Gupta [email protected], Yunjuan Liu, Chris Miller-Rosales, Fangzhou Wei, Edward Tuttle, Ekaterina Byers, Richard Marshak, and Richard MarshallAuthor Info & Affiliations
Volume 15, Number 5
https://doi.org/10.57264/cer-2025-0144
PDFFormats

Abstract

Aim: Prior research observed that pressure-enabled drug delivery (PEDD) counteracts intra-tumoral pressure during trans-arterial chemoembolization (TACE) and radioembolization (TARE), improving drug penetration, yet real-world evidence remains limited. This study examined outcomes associated with PEDD use, including in high-adopter facilities, and assessed potential cost avoidance associated with PEDD. Materials & methods: We used the Clarivate Real World Data repository to identify adults with hepatocellular carcinoma or secondary liver metastases who received TACE or TARE procedures (January 2020–March 2024). We compared baseline characteristics between PEDD and non-PEDD cohorts, then used a two-stage matching approach to develop a matched sample for comparative analyses. Facilities in the top fifth percentile of PEDD volume were examined separately. Results: In total, 603 PEDD and 16,210 non-PEDD patients were identified. PEDD patients had higher baseline disease burden on average. In matched analyses, PEDD was associated with reduced rates of fatigue overall (20.9% vs 26.4%, p < 0.05) and 30-day inpatient visits among patients receiving TACE procedures (8.0% vs 20.5%, p < 0.05). In high-adopter facilities, PEDD use was associated with reduced lymphopenia among all patients (0.6% vs 5.2%, p < 0.05) and reduced fatigue (19.2% vs 39.7%, p < 0.05) and lymphopenia (0.0% vs 8.2%, p < 0.05) among patients with secondary liver metastases. PEDD use was linked to a per-patient charge avoidance of $7734 through fewer complications ($4599) and inpatient stays ($3135). Conclusion: Despite greater patient comorbidity, PEDD use was associated with fewer post-procedure complications and lower healthcare resource utilization. Greater institutional experience may enhance patient outcomes. Reduced complications and hospitalizations can translate into cost avoidance, reinforcing the value of PEDD technology in clinical practice.

Plain language summary

What is this article about?

This study assessed a treatment method called pressure-enabled drug delivery (PEDD), which is used with procedures that deliver chemotherapy (trans-arterial chemoembolization, or TACE) or radiation (trans-arterial radioembolization, or TARE). The goal was to evaluate whether PEDD improves patient outcomes compared with standard methods and whether hospitals with more experience using PEDD achieve better results. The study also examined whether PEDD use can reduce costs by lowering the need for extra treatment after procedures.

What were the results?

The study included 603 people treated with PEDD and 16,210 treated without it. People who received PEDD generally were sicker at the start. PEDD patients had lower rates of fatigue and fewer hospital stays within 30 days after chemotherapy-based procedures. At hospitals that used PEDD more frequently, patients also had fewer blood-related problems and, for those with secondary liver metastases, lower rates of fatigue and lymphopenia. PEDD use was linked to avoided medical charges of $3135 from fewer hospital stays and $4599 from fewer complications per patient.

What do the results mean?

These findings suggest that PEDD can help patients recover with fewer side effects and hospital visits, even for those who are sicker at the start of treatment. Hospitals with more experience using PEDD may see the greatest benefits. Because PEDD reduces complications and hospital stays, it can also lower medical costs, supporting its value in clinical practice.

Supplementary Material

File (supplementary data.docx)

References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Zhong BY, Fan W, Guan JJ et al. Combination locoregional and systemic therapies in hepatocellular carcinoma. Lancet Gastroenterol. Hepatol. 10(4), 369–386 (2025).
PubMed
Google Scholar
•• Establishes the central role of trans-arterial chemoembolization (TACE) and trans-arterial radioembolization (TARE) in hepatocellular carcinoma management, supporting the clinical relevance of optimizing embolization approaches.
2.
d'Abadie P, Walrand S, Hesse M et al. Accurate non-tumoral 99mtc-maa absorbed dose prediction to plan optimized activities in liver radioembolization using resin microspheres. Phys. Med. 89, 250–257 (2021).
PubMed
Google Scholar
• Supports the importance of delivery precision and dose optimization in radioembolization.
3.
Sheth RA, Hesketh R, Kong DS, Wicky S, Oklu R. Barriers to drug delivery in interventional oncology. J. Vasc. Interv. Radiol. 24(8), 1201–1207 (2013).
PubMed
Google Scholar
•• Identifies physiologic barriers to intra-tumoral drug delivery, providing the mechanistic rationale for pressure-enabled drug delivery (PEDD).
4.
Heldin CH, Rubin K, Pietras K, Ostman A. High interstitial fluid pressure - an obstacle in cancer therapy. Nat. Rev. Cancer 4(10), 806–813 (2004).
PubMed
Google Scholar
• Describes tumor pressure as a barrier to therapeutic penetration, supporting the need for enhanced delivery techniques.
5.
Stylianopoulos T, Martin JD, Chauhan VP et al. Causes, consequences, and remedies for growth-induced solid stress in murine and human tumors. Proc. Natl Acad. Sci. USA 109(38), 15101–15108 (2012).
PubMed
Google Scholar
6.
Titano JJ, Fischman AM, Cherian A et al. End-hole versus microvalve infusion catheters in patients undergoing drug-eluting microspheres-tace for solitary hepatocellular carcinoma tumors: a retrospective analysis. Cardiovasc. Intervent. Radiol. 42(4), 560–568 (2019).
PubMed
Google Scholar
•• Demonstrates improved tumor response with pressure-modulating catheter technology, supporting PEDD-based approaches.
7.
Kim AY, Frantz S, Krishnan P et al. Short-term imaging response after drug-eluting embolic trans-arterial chemoembolization delivered with the surefire infusion system® for the treatment of hepatocellular carcinoma. PLoS ONE 12(9), e0183861 (2017).
PubMed
Google Scholar
•• Provides clinical evidence of improved embolization delivery with pressure-modulating catheter systems.
8.
Cancer stat facts: liver and intrahepatic bile duct cancer. https://seer.cancer.gov/statfacts/html/livibd.html
Google Scholar
9.
Adult primary liver cancer treatment (pdq®)–health professional version. https://www.cancer.gov/types/liver/hp/adult-liver-treatment-pdq
Google Scholar
10.
Cook K, Gupta D, Liu Y et al. Real-world evidence of pressure-enabled drug delivery for trans-arterial chemoembolization and radioembolization among patients with hepatocellular carcinoma and liver metastases. Curr. Med. Res. Opin. 40(4), 591–598 (2024).
PubMed
Google Scholar
12.
Jaroch DB, Liu Y, Kim AY, Katz SC, Cox BF, Hullinger TG. Intra-arterial pressure-enabled drug delivery significantly increases penetration of glass microspheres in a porcine liver tumor model. J. Vasc. Interv. Radiol. 35(10), 1525–1533; e4 (2024).
PubMed
Google Scholar
13.
Jaroch DB, Liu Y, Kim AY, Katz SC, Cox BF, Hullinger TG. Pressure-enabled drug delivery significantly increases intra-arterial delivery of embolic microspheres to liver tumors in a porcine model. J. Vasc. Interv. Radiol. 36(3), 499–504; e1 (2025).
PubMed
Google Scholar
14.
Hao K, Paik AJ, Han LH, Makary MS. Yttrium-90 radioembolization treatment strategies for management of hepatocellular carcinoma. World J. Radiol. 16(10), 512–527 (2024).
PubMed
Google Scholar
15.
Li C, Hickey R, Lewandowski RJ, Salem R. Transarterial radioembolization. In: IR Playbook: a Comprehensive Introduction to Interventional Radiology. Keefe NA, Haskal ZJJ, Park AW, Angle JF (Eds). Springer Nature, Switzerland, 475–484 (2024).
Google Scholar
16.
Jha AK. Back to the future: volume as a quality metric. JAMA 314(3), 214–215 (2015).
PubMed
Google Scholar
17.
Birkmeyer JD, Siewers AE, Finlayson EV et al. Hospital volume and surgical mortality in the united states. N. Engl. J. Med. 346(15), 1128–1137 (2002).
PubMed
Google Scholar
18.
Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the united states. N. Engl. J. Med. 349(22), 2117–2127 (2003).
PubMed
Google Scholar
|