CHEMOEMBOLIZATION WITH LIPIODOL AND DOXORUBICIN - APPLICABILITY IN BRITISH PATIENTS WITH HEPATOCELLULAR-CARCINOMA

Chemoembolisation has been extensively used as primary treatment for u nresectable hepatocellular carcinoma (HCC). In this unit, 185 patients with a new diagnosis of HCC not amenable to surgery were seen between 1988 and 1991. Intended therapy for these patients was chemoembolisat ion with doxorubicin (60 mg/m(2)) and lipiodol, repeated at six week i ntervals until it was technically no longer possible or until complete tumour response had been obtained. Chemoembolisation was possible in 67 of the 185 (37%). Reasons for exclusion were portal vein occlusion (n=36), decompensated cirrhosis (n=44), distant metastases (n=5), diff use tumour or unsuitable anatomy (tumour or vasculature) (n=11), patie nt refusal (n=11), and other (n=11). Patients excluded from treatment survived for a median of 10 weeks (range 3 days-19 months). In patient s treated, 18 had small HCC (<4 cm) and 49 had large or multifocal HCC . Chemoembolisation was carried out a median of two sessions for small and three sessions for large tumours. Ten of 18 patients with small H CC showed a 50% or greater reduction in tumour size. Five of 49 patien ts with large or multifocal tumours showed a response to treatment. Me dian overall survival for treated patients was 36 weeks (range 3 days- 4 years). One patient has subsequently undergone liver transplantation with no recurrence and minimal residual disease at transplantation. T wo other patients are alive three years after chemoembolisation, one w ith no evidence of recurrent disease. No patient was thought suitable for surgery after their response to chemoembolisation. Chemotherapy re lated complications were seen in 22%. Complications were significantly Department of more common in patients with larger tumours and poor li ver reserve. Five patients died as a result of chemotherapy related co mplications. In conclusion, only one third of UK patients with unresec table HCC are treatable by chemoembolisation. Results with small tumou rs are encouraging, with a high rate and the possibility of surgical i ntervention in previously inoperable disease. Large tumours, however, show a poor response and a significant incidence of side effects, sugg esting that this treatment offers little benefit in advanced disease.