TRANSARTERIAL EMBOLIZATION VERSUS SYMPTOMATIC TREATMENT IN PATIENTS WITH ADVANCED HEPATOCELLULAR-CARCINOMA - RESULTS OF A RANDOMIZED, CONTROLLED TRIAL IN A SINGLE INSTITUTION

This randomized, controlled trial assessed the effect of transarterial embolization (TAE) (without associated chemotherapy) on the survival of patients with nonsurgical hepatocellular carcinoma (HCC). Eighty co nsecutive patients were randomized to treatment with embolization (Gro up A, n = 40), or to symptomatic treatment (Group B, n = 40), there be ing no differences between both groups regarding the degree of liver f unction impairment and tumor stage. Eighty-two percent of the patients presented a self-limited postembolization syndrome, without treatment -related mortality. Fifty-five percent of the treated cases exhibited a partial response, which resulted in a lower probability of tumor pro gression during follow-up (57% vs. 77% at 1 year, P < .005). However, after a median follow-up of 24 months (30 deaths in each group), there are no differences in survival (Group A: 49% and 13%; Group B: 50% an d 27%, at 2 and 4 years, respectively; P = .72). The absence of differ ences was maintained even when dividing patients according to Child-Pu gh's grade, Okuda stage, or performance status test (PST). Furthermore , there were no differences in the probability of complications or in the need of hospital admissions. In conclusion, TAE has a marked antit umoral effect associated to a slower growth of the turner, but it does not improve the survival of patients with nonsurgical HCC.