Dong Hoo Joh, et al. Drug-eluting beads for caudate HCC 407 A B Figure 3. Complete necrosis of a previously noted lesion without remnant or new enhancement was observed (A: arterial phase, B: portal phase). A B Figure 4. Regression in the size of the necrotic lesion (3 cm diameter) without definite evidence of recurrence was noted on six-month post-embolization MRI (A: arterial phase, B: delayed phase). HCC, however, he refused the surgical treatment. TACE using DEB was performed after obtaining written informed consent for the procedure. During the first TACE session, hepatic angiogram revealed a definite hypervascular mass supplied by a small branch of the left hepatic artery without apparent arteriovenous shunt (Fig. 2A-B). After positioning the microcatheter tip at the left hepatic artery close to the tumor-feeding branch, a mixture of DEB (DC Bead®, 1 vial of 300~500 μm diameter, Biocompatibles, UK) loaded with doxorubicin (50 mg) and contrast agent was infused until the flow through the tumor-feeding artery was slowed down. After the infusion, angiogram showed occluded tumor-feeding branch and no tumor staining (Fig. 2C). He had no serious adverse event after embolization except mild abdominal pain that was controlled with oral analgesic (tramadol 50 mg per os tid). One-month post-embolization CT (Fig. 3A-B) and six-month post-embolization MRI (Fig. 4A-B) showed complete necrosis without viable portions. Follow-up α-fetoprotein level was 3.89 ng/mL, and PIVKA-II level was 21 mAU/mL. This patient remains in good health without cancer recurrence 6 months after the procedure. DISCUSSION Although HCC arising in the caudate lobe is no common in clinical setting, it is problematic due to its deep anatomical location and close relationship with major vasculatures. Caudate lobe occupies the space below the hepatic hilum in close proximity to ductal and portal confluences and the proximal hepatic arteries, above the inferior vena cava.4 Frequent invasion of the vessels and frequent formation of tumor thrombi in portal vein and inferior vena cava might contribute to intra- and extrahepatic metastases.5 The limitations in proper therapeutic