INTRAARTERIAL CHEMOEMBOLIZATION IN PATIENTS WITH HEPATOCELLULAR-CARCINOMA

Hepatocellular carcinoma occurs almost exclusively in patients with ci rrhosis, at least in the West. In most of these patients, potential cu rative treatments, such as resection or percutaneous alcohol injection , are usually contra-indicated. Transarterial chemoembolization may in duce tumor necrosis. In order to avoid massive necrosis of the non tum oral liver, two major contra-indications have been identified: inadequ ate portal flow and liver failure. The influence of chemoembolization on survival was thought to be high on the basis of non randomized tria ls. However, no beneficial effects on survival were observed in three randomized trials. In these trials, the beneficial effect on tumor nec rosis was counterbalanced by frequent deleterious effects on liver fun ction. Moreover, progressive liver atrophy may follow repeated procedu res. As there is no alternative treatment for most of these patients a nd chemoembolization can still be beneficial in selected cases, effort s have been made to improve patient selection and method to improve th e results. Good liver function, a normal portal flow, and a well limit ed hypervascularized tumor are necessary conditions for treatment, whi ch may even be curative when used in association with percutaneous alc ohol injection. Moreover, arterial embolization can be performed witho ut chemotherapy, and the procedure should not be repeated in the short term.