CHEMOEMBOLIZATION VERSUS CHEMOTHERAPY IN ELDERLY PATIENTS WITH UNRESECTABLE HEPATOCELLULAR-CARCINOMA AND CONTRAST UPTAKE AS PROGNOSTIC FACTOR

Background. Age is considered one of the important contraindications t o surgery for hepatocellular carcinoma (HCC) in cirrhosis patients. We therefore evaluated the safety and prevalence of side effects in endo arterial therapy (EAT) in subjects aged over 65 years compared with yo unger treated patients. Methods. Thirty-eight patients with HCC aged 6 5 years and over underwent transcatheter arterial chemoembolization (T ACE) (n = 28) or intraarterial chemotherapy (IAC) (n = LO). The surviv al rate was calculated using Kaplan-Meier's method with respect to a c ontrol group consisting of younger treated subjects (44 TACE; 21 IAC) comparable for stage of HCC and severity of the underlying cirrhosis. Results, The comparison between the two groups regarding side effects, procedure-related death, and survival did not show any difference con sidering the whole EAT procedure. TACE in elderly subjects reached a s tatistically lower outcome with respect to younger patients (p <.025) but remained statistically superior in survival versus both older and younger patients treated with IAC (p <.05, respectively). Stratifying the patients following the degree of Lipiodol uptake of tumor mass in the three groups (Group I, > 75%; Group II, 50-75%; Group III, < 50%), in the young subjects a higher probability of survival was strictly c orrelated to a degree of uptake over 75%, while in the elderly patient s an impregnation over 50% was sufficient to obtain a satisfactory sur vival curve. Conclusions, EAT is a reliable and safe therapeutic optio n for the geriatric patient with HCC, with TACE showing a better effic acy than IAC, requiring a lesser degree of Lipiodol uptake to achieve an improvement of outcome.