Treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization: Comparison of planned periodic chemoembolization and chemoembolization based on tumor response

OBJECTIVE. The purpose of our study was to assess the efficacy of transcath eter arterial chemoembolization in the treatment of hepatocellular carcinom a using two different infusion schedules. MATERIALS AND METHODS. Chemoembolization with lipiodol-mediated injection o f doxorubicin was performed in 160 patients. In the first group of 80 patie nts, conventional chemoembolization was initially planned to be repeated at least three times at 2-month intervals. In the second group of 80 patients , chemoembolization was used selectively and repeated only when necessary o n the basis of follow-up CT or MR imaging. According to the Okuda classific ation, 72 patients were stage 1, 33 belonging to group 1 (subgroup 1, Okuda I) and 39 belonging to group 2 (subgroup 2, Okuda 1). Eighty-eight patient s were stage 2, 47 belonging to group 1 (subgroup 1, Okuda 2) and 41 belong ing to group 2 (subgroup 2, Okuda 2). RESULTS. Complications of transcatheter arterial chemoembolization occurred in 19 patients from group 1 and six patients from group 2 (p < .001). The mean time between the first and the third courses was significantly differe nt between group 1 (4 months) and group 2 (14 months) (p < .001). The 1-yea r, 2-year, and 3-year survival rates were significantly different between s ubgroup 1, Okuda 1, (58%, 28%, 11%) and subgroup 2, Okuda 1 (89%, 68%, 39%) (p < . 001), and between subgroup 1, Okuda 2 (19%, 0%, 0%), and subgroup 2 , Okuda 2 (48%, 31%, 15%) (p < .001). CONCLUSION. The efficacy and tolerability of chemoembolization increase whe n it is used selectively and repeated only when necessary. Such technical c onsiderations might explain some of the discrepancies of the results of che moembolization in published data.