TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION IN INOPERABLE HEPATOCELLULAR-CARCINOMA - 4-YEAR FOLLOW-UP

PURPOSE: To evaluate the efficacy of repeated chemoembolization in pat ients with inoperable hepatocellular carcinoma (HCC). PATIENTS AND MET HODS: One hundred thirty-two patients with HCC underwent transcatheter arterial chemoembolization with an emulsion of iodized oil and cispla tin. In 104 patients, ''light'' gelatin sponge embolization was also u sed. Chemoembolization was repeated every 1.5-3.0 months in most patie nts (range, one to 18 chemoembolization sessions). RESULTS: In 74 pati ents, the HCCs became smaller or disappeared after chemoembolization. Decreases in size were seen in 55 of 76 HCCs 9 cm or smaller, 17 of 42 HCCs between 9 and 18 cm, and two of 14 HCCs larger than 18 cm. Use o f gelatin sponge pledgets enhanced the response in tumors larger than 9 cm. Seven of 74 HCCs that responded to chemoembolization increased i n size later. New daughter nodules that appeared at other sites respon ded to chemoembolization in 24 of 40 patients. Further new nodules app eared in 14 of 24 patients, and in six patients they responded to ther apy. Median survival was 26 months for patients with responsive HCCs a nd 5 months for those with unresponsive lesions. CONCLUSION: Tumor siz e at the start of chemoembolization influenced the response to treatme nt and survival. The addition of gelatin sponge improved results only in tumors larger than 9 cm. Recurrence after an initial response was d ue more to the appearance of new daughter nodules in new locations rat her than recrudescence of the presenting tumor.