A COMPARISON OF CHEMOEMBOLIZATION WITH CONVENTIONAL CHEMOTHERAPY AND SYMPTOMATIC TREATMENT IN CIRRHOTIC-PATIENTS WITH HEPATOCELLULAR-CARCINOMA

Background/Aims: The results of transcatheter arterial chemoembolizati on (TACE) in 28 cirrhotic patients with advanced hepatocellular carcin oma (HCC) were compared to those obtained in 15 cirrhotic patients wit h HCC treated with systemic chemotherapy, and 14 patients with HCC rec eiving no specific anti-cancer treatment. Materials and Methods: From November, 1986 through May 1994, 235 patients with HCC were seen by th e investigators. Twenty eight of these patients actually received TACE . The chemotherapeutic agent used was mitomycin C mixed with Lipiodol and arterial embolization was achieved using Gelfoam. In 19 of 28 Ease s treated with TACE, the embolization. was limited to an artery feedin g the tremor, thereby avoiding liver cell injury in non-tumor tissue. In 9 others, the main left or right hepatic artery was embolized. The results obtained in these 28 cases were compared to those obtained in 15 patients with HCC Larger than. 5 cm. who received systemic mitomyci n C and doxorubicin chemotherapy and with those obtained in 14 patient s who received no specific anti-tumor therapy. Results: One patient di ed of liver failure related to the TACE and three patients died of ble eding from esophageal varices within weeks of the TACE procedure. Two of the remaining 24 patients are alive with a follow-up of 6 and 22 mo nths. Twenty-six of the 28 patients treated with TACE died within 1 an d 28 months of the initiation of the TACE therapy. The mean survival o f those receiving TACE was 13.0 months. Chemotherapy without embolizat ion yielded a mean survival of 7.2 months. The mean survival of the pa tients receiving no specific anti-cancer treatment was only 6.9 months . There was no statistical differences between the survival of those r eceiving systemic chemotherapy and those receiving no specific treatme nt. In contrast, the mean survival of the group receiving TACE was sig nificantly greater than that of either of the other two groups (p < 0. 005). Conclusions: These data suggest that TACE provides the best surv ival for individuals with Larger hepatocellular carcinomas (> 5 cm) no t eligible for surgery or percutaneous ethanol injection (PEI).