UNRESECTABLE HEPATOCELLULAR-CARCINOMA IN CIRRHOSIS - SURVIVAL, PROGNOSTIC FACTORS, AND UNEXPECTED SIDE-EFFECTS AFTER TRANSCATHETER ARTERIALCHEMOEMBOLIZATION

To evaluate the efficacy of transcatheter arterial chemoembolization i n the treatment of hepatocellular carcinoma, the prognostic factors, a nd the side effects, 72 patients undergoing 170 chemoembolizations wit h lipiodol-mediated injection of adriamycin were investigated. The 1-, 2-, and 3-year survivals are 83, 61, and 56%, respectively. Significa nt prognostic factors for survival (by Mantael-Haenszel) are Child-Pug h and Okuda status (p = 0.00001 and p = 0.01 respectively), number of TACE courses (p = 0.002) and of courses completed with embolization (p = 0.05), stabilization or reduction of alpha-fetoprotein (p = 0.003), and concurrent tamoxifen treatment (p = 0.04). Side effects included fever, pain, increased serum amylase and transaminase levels, and one liver abscess with death of liver failure. In addition, mild hyperglyc emia was observed in 19% of patients and severe in 8% (with one hypero smolar diabetic coma), in the absence of pancreatic damage. In conclus ion, transcatheter arterial chemoembolization is useful in patients wi th unresectable hepatocellular carcinoma. Prognostic factors are Child -Pugh and Okuda status, number of TACE courses and of embolizations, c hanges of alpha-fetoprotein levels, and association with tamoxifen tre atment. The development of mild to severe changes of glucose metabolis m suggests that glucose tolerance should be evaluated before and glyce mia strictly monitored after each TACE course.