Transcatheter arterial chemoembolization as primary treatment for hepatocellular carcinoma

• Published in: The American journal of surgery 1999-05, Vol.177 (5), p.405-410
• Main Authors: Rose, D.Michael, Chapman, William C, Brockenbrough, Andrew T, Wright, J.Kelly, Rose, Amy T, Meranze, Steven, Mazer, Murray, Blair, Taylor, Blanke, C.D, Debelak, J.P, Pinson, C.Wright
• Format: Article
• Language: English
• Subjects: Abdominal Pain - etiology; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cancer; Cancer therapies; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Catheterization; Chemoembolization, Therapeutic - adverse effects; Chemoembolization, Therapeutic - methods; Child; Child, Preschool; Cirrhosis; Complications; Demographics; Embolization; Female; Fever - etiology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatic Artery; Hepatitis; Hepatitis C; Hepatocellular carcinoma; Humans; Liver cancer; Liver cirrhosis; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Median (statistics); Medical sciences; Middle Aged; Nausea - etiology; Patients; Prognosis; Retrospective Studies; Statistical significance; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival; Survival analysis; Tomography; Treatment Outcome; Tumors; Veins & arteries; Vomiting; Vomiting - etiology
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(99)00069-0

Background: Hepatocellular carcinoma (HCC) in Western populations has historically been associated with poor survival. Methods: In this study, we conducted a 7-year retrospective analysis of patients with HCC undergoing transcatheter arterial chemoembolization (TACE) at our institution and examined demographics, outcomes, and complications. Results: During the period of study, 39 patients (25 male [64%], mean age 58 [range 17 to 86]) underwent a total of 78 chemoembolization treatments. During the same time period, an additional 31 patients received supportive care only. The majority of patients had late stage disease (American Joint Committee on Cancer stage III, IVa, or IVb) with no statistical difference noted between the two groups ( P = 0.2). However, patients receiving supportive care only had significantly worse hepatic dysfunction by Child’s classification ( P = 0.005). Twenty-nine patients (74%) had documented cirrhosis, with hepatitis C being the most common cause in 11 of 29 (38%). In patients undergoing TACE, overall actuarial survival was 35%, 20%, and 11% at 1, 2, and 3 years with a median survival of 9.2 months, significantly improved over the group receiving supportive care only ( P < 0.0001). Median survival for the group receiving supportive care was less than 3 months. Neither age nor stage had a significant impact on survival. The most common complications of TACE included transient nausea, abdominal pain, vomiting, and fever. Conclusions: TACE is a safe and effective therapeutic option for selected patients with HCC not amenable to surgical intervention.