A randomized clinical trial comparing autologous blood clot and gelfoam intransarterial chemoembolization for inoperable hepatocellular carcinoma

Background/Aim: Inoperable hepatocellular carcinoma is common in Asia and i s usually treated with repeated transarterial chemoembolization. Gunji et a l, showed better survival and fewer complications with autologous blood clo t as compared with gelfoam used for embolization, Our aim was to compare th e effect of blood clot versus gelfoam, Methods: We conducted a prospective randomized trial in 100 patients with i noperable hepatocellular carcinoma, and compared the side effects and cumul ative survival in the two groups. Cox's proportional hazard model was used to study the prognostic factors, Results: The diameter of the main tumor wa s 7.9+/-4.6 cm, Our study did not show additional beneficial effects of blo od clot. The proportion of side effects was similar and the common ones inc luded fever, pain and vomiting. Though the hepatic artery remained patent f or a longer period with blood clot (p=0.061), there was no difference in su rvival (p=0.129 for Okuda I disease and p=0.388 for Okuda II disease). Subg roup analysis showed longer survival in patients with vascular occlusion (p =0.034 for Okuda I and p=0.029 for Okuda II disease). The independent facto rs of survival were sex, Child's class, Okuda stage, tumor type and presenc e of metastases, Conclusion: This study showed no additional benefits of blood clot in patie nts with inoperable hepatocellular carcinoma, in Okuda I and II disease. Th e longer survival in patients with vascular occlusion suggested that the da mage to normal liver tissue by planned periodic transarterial chemoemboliza tion may outweigh its benefit in later sessions of repeated TACE in certain patients.