EFFICACY OF TRANSARTERIAL TARGETED TREATMENTS ON SURVIVAL OF PATIENTSWITH HEPATOCELLULAR-CARCINOMA - AN ITALIAN EXPERIENCE

Background. Most patients with hepatocellular carcinoma (HCC) are not suitable for surgical therapy. Systemic chemotherapy, immunotherapy, a nd hormonotherapy have not had convincingly acceptable results. Theref ore, transarterial catheter-targeted therapies such as intraarterial c hemotherapy (IAC), possibly followed by transcatheter arterial chemoem bolization (TACE), have been proposed. Methods. A survival analysis cu rve was drawn using the Kaplan-Meier method for 164 patients, 100 with HCC who underwent TACE (69) or IAC (31), and a matched historic group of 64 who did not receive specific antineoplastic treatment. Results. A significantly more favorable survival was observed for TACE-treated patients compared with IAC-treated patients (P < 0.001); TACE- and IA C-treated patients had a statistically superior survival than that of untreated patients (P < 0.001 and P < 0.025, respectively). This diffe rence was still significant (P < 0.001) when the patients were subdivi ded into Classes A and B and Stages I and II following Child's and Oku da's criteria. The TACE- and IAC-treated groups had a good relationshi p between technical efficacy of therapy and survival. Stratifying the patients according to the degree of iodized oil (Lipiodol Ultrafluid, Guerbet, Aulnay-Sous-Bois, France) uptake in the three groups with Gro up 1 having an uptake greater than 75% of tumor mass, Group 2 having a n uptake of 50%-75%, and Group 3 having an uptake less than 50%, survi val at 6, 12, 24, 36, and 48 months was calculated as 94%, 88%, 67%, 5 3%, and 30%, respectively, for Group 1; 86%, 68%, 13%, 13%, and 0% for Group 2, and 43%, 23%, 6%, 6%, and 0% for Group 3 (Group 1 vs. Group 2: P < 0.001; Group 1 vs. Group 3: P < 0.001; Group 2 vs. Group 3: P < 0.001, respectively). The most important side effects after the intra arterial procedure were fever (46.2%), abdominal pain (36.6%), chemica l cholecystitis (8%), and pancreatitis (1.7%). Death strictly related to treatment occurred in two patients; one had massive bleeding due to ruptured esophageal varices, and the other had a subphrenic abscess o f a superficial HCC of the VIII segment. Conclusions. Transcatheter ar terial chemoembolization and IAC were effective and relatively safe, a nd the authors believe that they have a primary role in treating patie nts with unresectable HCC larger than 5 cm; iodized oil uptake can be considered a suitable prognostic marker.