Evaluation of responses to chemoembolization in patients with unresectable hepatocellular carcinoma

• Published in: Cancer 2003-02, Vol.97 (4), p.1042-1050
• Main Authors: Ebied, Osama M., Federle, Michael P., Carr, Brian I., Pealer, Karen M., Li, Wei, Amesur, Nikhil, Zajko, Albert
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic agents; Biological and medical sciences; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic; chemotherapy; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); computed tomography; efficacy studies; embolization; Female; hepatocellular; Humans; liver; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Male; Medical sciences; Middle Aged; neoplasms; Pharmacology. Drug treatments; Retrospective Studies; Survival Analysis; Tomography, X-Ray Computed
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.11111

BACKGROUND The authors used computed tomography (CT) scans to correlate the changes in tumor vascularity, necrosis, and size with response and survival after transcatheter arterial chemoembolization (TACE) in patients with advanced, unresectable, hepatocellular carcinoma (HCC). METHODS The authors studied 72 patients with biopsy‐proven, unresectable HCC and focused on 186 individual tumor masses. A baseline, multiphase, helical CT was performed and at least three follow‐up CT scans were performed after treatment by TACE. Tumors were classified as hypervascular or hypovascular and patients were classified as responders or nonresponders based on CT evidence of altered tumor size, tumor necrosis, and the appearance of new tumors. A new scoring system was used to monitor patient response to TACE. RESULTS Thirty‐eight patients were responders and 34 were nonresponders. Patient survival was significantly increased (P = 0.009) in patients who were hypervascular responders. Survival also was increased in hypervascular nonresponders compared with hypovascular nonresponders (P = 0.008) and in hypovascular responders compared with hypovascular nonresponders (P = 0.002). Response to chemoembolization was found to be significantly (P = 0.02) and inversely proportional to tumor size, but the number of tumor foci in an individual patient was not predictive. CONCLUSIONS TACE appears to result in improved survival among HCC patients with hypervascular tumors who responded to therapy. However, even patients classified by CT as hypervascular nonresponders and hypovascular responders have improved survival. Cancer 2003;97:1042–50. © 2003 American Cancer Society. DOI 10.1002/cncr.11111 Transcatheter arterial chemoembolization results in improved survival among patients with hypervascular tumors and hepatocellular carcinoma. However, even patients classified by computed tomographic scan as hypervascular nonresponders and hypovascular responders have improved survival.