The efficacy and tolerability of transarterial chemo-embolization (TACE) compared with transarterial embolization (TAE) for patients with unresectable hepatocellular carcinoma (HCC).
4595 Background: Radiologic procedures that involve embolizing branches of the hepatic artery lengthen survival for patients with unresectable HCC, but the benefit of administering intrahepatic arterial chemotherapy during the embolization procedure is uncertain. METHODS: A retrospective review of all patients with HCC and undergoing an embolization in the last 10 years and with 2 years of follow-up data was undertaken at two institutions to compare the survival and TTP of patients receiving TACE compared with TAE. Prognostic factors analyzed included age, gender, race, largest tumor size, number of tumors, macrovascular invasion, AFP, Child's class, and CLIP score. RESULTS: 122 pts with the following characteristics were included in the analysis: 71% Caucasian, 22% African American, 52% HCV+, 13% HBV+, 66% with cirrhosis, Child's A/B/C 70/25/5%, CLIP Score 0,1/2/>3 52/26/21%, 72% had either 1 or 2 tumors, 14% macrovascular invasion, 16% portal vein branch thrombosis, 20% extrahepatic disease. The procedure (TACE (51%, the majority receiving doxorubicin plus mitomycin C) and TAE (49%).was completed in one session in 87%. A subsequent embolization was performed in 37% for progression or new disease. The embolizing material was ethiodised oil in 39%, polyacrylamide/gelatin in 43%, and polyvinyl alcohol in 41%. The procedures were equally well tolerated. Although 37% of patients experienced an adverse event, readmission to the hospital was required in only 10%. One patient experienced fulminant hepatic failure. The median survival for TAE was 19.6 mo (95% CI 10.6-28.4) compared with 12.9mo (95% CI 7.0-19.5) for TACE (p=0.066). The TTP for TAE was 3.2mo (95% CI 2.1-6.0) compared with 4.1 mo (95% CI 2.1-5.6 for TACE (p=0.79). On multivariate analysis, the trend towards a difference in survival for TAE was eliminated and only CLIP score, AFP, and largest tumor remained as prognostic factors. CONCLUSIONS: This retropsective review suggests that adding chemotherapy to embolization does not improve survival compared with bland embolization in pts with HCC. Future efforts should focus on adjunctive therapies following the embolization to prevent progression or new primary tumors. No significant financial relationships to disclose.
Hanks, BA; Suhocki, PV; DeLong, DM; Doan, PL; Liu, E; Tsai, AL; Burke, CT; Bernard, SA; O'Neil, BH; Morse, MA
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