Transcatheter arterial chemoembolization as primary treatment for hepatocellular carcinoma

BACKGROUND: Hepatocellular carcinoma (HCC) in Western populations has histo rically been associated with poor survival. METHODS: In this study, we conducted a 7-year retrospective analysis of pat ients with HCC undergoing transcatheter arterial chemoembolization (TACE) a t our institution and examined demographics, outcomes, and complications. R ESULTS: During the period of study, 39 patients (25 male [64%], mean age 58 [range 17 to 86]) underwent a total of 78 chemoembolization treatments. Du ring the same time period, an additional 31 patients received supportive ca re only. The majority of patients had late stage disease (American Joint Co mmittee on Cancer stage III, IVa, or IVb) with no statistical difference no ted between the two groups (P = 0.2). However, patients receiving supportiv e care only had significantly worse hepatic dysfunction by Child's classifi cation (P = 0.005). Twenty-nine patients (74%) had documented cirrhosis, wi th hepatitis C being the most common cause in 11 of 29 (38%), In patients u ndergoing TACE, overall actuarial survival was 35%, 20%, and 11% at 1, 2, a nd 3 years with a median survival of 9.2 months, significantly improved ove r the group receiving supportive care only (P < 0.0001). Median survival fo r the group receiving supportive care was less than 3 months. Neither age n or stage had a significant impact on survival. The most common complication s of TACE included transient nausea, abdominal pain, vomiting, and fever. CONCLUSIONS: TACE is a safe and effective therapeutic option for selected p atients with HCC not amenable to surgical intervention. Am J Surg, 1999;177 :405-410, (C) 1999 by Excerpta Medica, Inc.