Transcatheter arterial chemoembolization therapy using iodized oil for patients with unresectable hepatocellular carcinoma - Evaluation of three kinds of regimens and analysis of prognostic factors

BACKGROUND. The current study was conducted to evaluate retrospectively the effects of three kinds of regimens used in transcatheter arterial chemoemb olization (TACE) in patients with unresectable hepatocellular carcinoma (HC C) and patients' prognosis, and to analyze their prognostic factors. METHODS. The study population was comprised of 152 patients who were treate d by TACE alone. Three kinds of regimens were used successively: doxorubici n hydrochloride (ADM) and mitomycin C mixed with iodized oil in 26 patients (ADMOS group), a combination of cisplatin (CDDP) solution and ADMOS in 70 patients (CDDP-ADMOS group), and CDDP powder and pirarubicin hydrochloride mixed with iodized oil in 56 patients (CTLS group). The CTLS group was comp rised of patients with significantly worse background factors than the othe r two groups. RESULTS. The initial tumor response rate with a > 50% reduction was 12%, 23 %, and 30%, respectively, in the ADMOS, CDDP-ADMOS, and CTLS groups. CTLS w as significantly more effective than ADMOS (P < 0.05), and slightly but not significantly better than CDDP-ADMOS (P <0.1). The cumulative survival rat es for the ADMOS, CDDP-ADMOS, and CTLS groups were 59.0%, 70.1%, and 72.0%, respectively, at 1 year; OR, 16.3%, and 29.8%, respectively, at 3 years; a nd 0%, 4.1%, and 16.8%, respectively, at 5 years, with median survival time s of 448 days, 574 days, and 758 days, respectively. The CTLS group showed a slightly but not significantly better survival than the ADMOS and CDDP-AD MOS groups (P <0.1). Multivariate analysis indicated that the significantly important prognostic factors tin order) were extrahepatic metastasis follo wed by the TACE regimen, serum alpha-fetoprotein levels, and portal vein in volvement and that CTLS was the best of the three regimens. CONCLUSIONS. Although TACE, using an effective regimen, improves clinical r esults, tumor factors appear to be more important when determining prognosi s. (C) 2000 American Cancer Society.