Purpose
To evaluate local tumor control and survival rate after repeated transarterial chemoembolization using two different protocols in hepatocellular carcinoma (HCC) patients.
Materials and Methods
A total of 190 patients (mean, 68 years) with HCC were repeatedly treated with transarterial chemoembolization in 4-week intervals. The chemotherapy protocol consisted of mitomycin C alone ( n = 111) and mitomycin C with gemcitabine ( n = 79). Embolization was performed with lipiodol and microspheres. Tumor response was evaluated by magnetic resonance imaging using Response Evaluation Criteria In Solid Tumors (RECIST) criteria. Survival rates were calculated using Kaplan-Meier method.
Results
In the mitomycin C–only group, we observed partial response in 38.8% (43/111), stable disease in 27% (30/111), and progressive disease in 34.2% (38/111). In the mitomycin C/gemcitabine group ( n = 79), partial response was observed in 43% (34/79), stable disease in 16.5% (13/79) and progressive disease in 40.5% (32/79). The overall 1- and 2-year survival rates were 56% and 28%, respectively. The overall median survival time from the start of transarterial chemoembolization treatment was 15 months. The median survival of patients treated with mitomycin C was 16.5 months and it was 12 months for patients treated with a combination of mitomycin C and gemcitabine. No statistically significant difference between the two groups was observed ( P = .7).
Conclusion
Chemoembolization is an effective minimally invasive therapy option for palliative treatment of HCC patients. Mitomycin C only proves to be effective, the addition of gemcitabine was not advantageous.
Hepatocellular carcinoma (HCC) is one of the most common solid-organ malignancies worldwide. Moreover, recent data suggest that the incidence and mortality of HCC in western nations is on the rise, and HCC is currently the leading cause of death among cirrhotic patients .
However, most HCC patients are unresectable at diagnosis because of multicentricity, large tumor size or a poor hepatic functional reserve due to preexisting cirrhosis, or they are not transplantable because of an advanced tumor stage or severe comorbidity . Therefore transarterial chemoembolization seems to be more important as a treatment strategy .
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Materials and methods
Patients
Get Radiology Tree app to read full this article<
Table 1
Baseline Characteristics of Patients in the Mitomycin C only and Mitomycin C with Gemcitabine Group
Mitomycin n = 111 Mitomycin and gemcitabine n = 79 Age, mean years 69 67 Men, women 84, 27 53, 26 Child-Pugh class A 62 27 B 14 3 Transarterial chemoembolization sessions 477 458 Treatment Palliative 91 (82%) 53 (67%)P = .0827 Neoadjuvant 20 (18%) 26 (33%)P = .0730 Mean diameter of nodule 5.42 cm 3.9 cm
Get Radiology Tree app to read full this article<
Indication and Contraindication for Transarterial Chemoembolization
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Chemoembolization Therapy
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Patient Evaluation and Follow-up
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Quantitative and Statistical Evaluation
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Results
MRI Findings
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Survival Analysis
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Discussion
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
References
1. Bruix J., Sala M., Llovet J.: Chemoembolization for hepatocellular carcinoma. Gastroenterology 2004; 127: pp. 179-188.
2. Taylor-Robinson S.D., Foster G.R., Arora S., et. al.: Increase in primary liver cancer in the UK, 1979–94. Lancet 1997; 350: pp. 1142-1143.
3. Llovet J., Sala M.: Non-surgical therapies of hepatocellular carcinoma. Eur J Gastroenterol Hepatol 2005; 17: pp. 505-513.
4. Llovet J., Burroughs A., Bruix J.: Hepatocellular carcinoma. Lancet 2003; 362: pp. 1907-1917.
5. Brown B.D., Geschwind F., Soulen M.C., et. al.: Society of interventional radiology position statement on chemoembolization of hepatic malignancies. J Vasc Interv Radiol 2006; 17: pp. 217-223.
6. BiAS. Für Windows, version 8.3 1989–2007. Dr. Hans Ackermann/Goethe Universität Frankfurt am Main, Germany.
7. Doffoël M., Bonnetain F., Bouché O., et. al.: Multicentre randomized phase III trial comparing tamoxifen alone or with transarterial Lipiodol chemoembolization for unresectable hepatocellular carcinoma in cirrhotic patients (Fédération Francophone de Cancérologie Digestive 9402). Eur J Cancer 2008; 44: pp. 528-538.
8. Seldinger S.I.: Catheter replacement of needle in percutaneous arteriography: a new technique. Acta Radiol 1953; 39: pp. 368-372.
9. Therasse P., Arbuck S.G., Eisenhauer E.A., et. al.: New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000; 92: pp. 205-216.
10. Kaplan E.L., Meier P.: Nonparametic estimation from incomplete observation. J Am Stat Assoc 1958; 53: pp. 457-481.
11. Zangos S., Eichler K., Balzer J.O., et. al.: Large-sized hepatocellular carcinoma (HCC): a neoadjuvant treatment protocol with repetitive transarterial chemoembolization (TACE) before percutaneous MR-guided laser-induced thermotherapy (LITT). Eur Radiol 2007; 17: pp. 553-563.
12. Zang Z., Liu Q., He J., et. al.: The effect o preoperative transcatheter hepatic arterial chemoembolization on disease-free after hepatectomy for hepatocellular carcinoma. Cancer 2000; 31: pp. 2370-2377.
13. Vogl T.J., Straub R., Eichler K., et. al.: Malignant liver tumor treated with MR imaging-guided laser-induced thermotherapy: experience with complications in 899 patients (2,520 lesions). Radiology 2002; 225: pp. 367-377.
14. Nagasue N., Kohno H., Chang Y.C., et. al.: Liver resection for hepatocellular carcinoma. Results of 229 consecutive patients during 11 years. Ann Surg 1993; 217: pp. 375-384.
15. Nakashima T., Okuda K., Kojioro M., et. al.: Pathology of hepatocellular carcinoma in Japan: 232 consecutive cases autopsied in ten years. Cancer 1983; 51: pp. 863-877.
16. Nakamura H., Tanaka T., Hori S., et. al.: Transcatheter embolization of hepatocellular carcinoma: assessment of efficacy in cases of resection following embolization. Radiology 1983; 147: pp. 401-405.
17. Vogl T.J., Trapp M., Schroeder H., et. al.: Transarterial chemoembolization for hepatocellular carcinoma: volumetric and morphologic CT criteria for assessment of prognosis and therapeutic success—results from a liver transplantation center. Radiology 2000; 214: pp. 349-357.
18. Marelli L., Stigliano R., Triantos C., et. al.: Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol 2007; 30: pp. 6-25.
19. Okuda K., Ohtsuki T., Obata H., et. al.: Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 1985; 56: pp. 918-928.
20. Zangos S., Gille T., Eichler K., et. al.: Transarterielle chemoembolisation bei hepatozellulären karzinomen: technik, indikationsstellung, ergebnisse. Der Radiologe 2001; 41: pp. 906-914.
21. Poyanli A., Rozanes I., Acunas B., et. al.: Palliative treatment of hepatocellular carcinoma by chemoembolization. Acta Radiol 2001; 42: pp. 602-607.
22. Llovet J.L., Real M.I., Montaña X., et. al.: Arterial embolization or chemoembolization versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomized controlled trial. Lancet 2002; 359: pp. 1734-1739.
23. Kirchhoff T.D., Bleck J.S., Dettmer A., et. al.: Transarterial chemoembolization using degradable starch microspheres and iodized oil in the treatment of advanced hepatocellular carcinoma: evaluation of tumor response, toxicity, and survival. Hepatobil Pancreat Dis Int 2007; 3: pp. 259-266.
24. Varela M., Real M., Burrel M., et. al.: Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 2009; 46: pp. 474-481.