Abstract
To evaluate the efficacy of transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma, the prognostic factors, and the side effects, 72 patients undergoing 170 chemoembolizations with lipiodol-mediated injection of adriamycin were investigated. The 1-, 2-, and 3-year survivals are 83, 61, and 56%, respectively. Significant prognostic factors for survival (by Mantael-Haenszel) are Child-Pugh and Okuda status (p=0.00001 and p=0.01 respectively), number of TACE courses (p=0.002) and of courses completed with embolization (p=0.05), stabilization or reduction of α-fetoprotein (p=0.003), and concurrent tamoxifen treatment (p=0.04). Side effects included fever, pain, increased serum amylase and transaminase levels, and one liver abscess with death of liver failure. In addition, mild hyperglycemia was observed in 19% of patients and severe in 8% (with one hyperosmolar diabetic coma), in the absence of pancreatic damage. In conclusion, transcatheter arterial chemoembolization is useful in patients with unresectable hepatocellular carcinoma. Prognostic factors are Child-Pugh and Okuda status, number of TACE courses and of embolizations, changes of α-fetoprotein levels, and association with tamoxifen treatment. The development of mild to severe changes of glucose metabolism suggests that glucose tolerance should be evaluated before and glycemia strictly monitored after each TACE course.
Similar content being viewed by others
References
Kasugai H, Kojima J, Tatsuta M, Okuda S, Sasaki Y, Imaoka S, Fujita M, Ishiguro S: Treatment of hepatocellular carcinoma by transcatheter arterial embolisation combined with intraarterial infusion of a mixture of cisplatin and ethiodized oil. Gastroenterology 97:965–971, 1989
Ikeda K, Kumada H, Saitoh S, Arase Y, Chayama K: Effect of repeated transcatheter arterial embolisation on the survival time in patients with hepatocellular carcinoma. Cancer 68:2150–2154, 1991
Beppu T, Ohara C, Yamaguchi Y, Ichihara T, Yamanaka T, Katafuchi S, Ikei S, Mori K, Fukushima S, Nakano M, Ogawa M: A new approach to chemoembolisation for unresectable hepatocellular carcinoma using aclarubicin microspheres in combination with cisplatin suspended in iodized oil. Cancer 68:2555–2560, 1991
Ngan H, Lai CL, Fan ST, Lai ECS, Yuen WK, Tso WK: Treatment of inoperable hepatocellular carcinoma by transcatheter arterial chemoembolisation using an emulsion of cisplatin in iodized oil and gelfoam. Clin Radiol 47:315–320, 1993
Pelletier G, Roche A, Ink O, Anciaux ML, Derhy S, Rougier P, Lenoir C, Attali P, Etienne JP: A randomized trial of hepatic arterial chemoembolisation in patients with unresectable hepatocellular carcinoma. J Hepatol 11:181–184, 1990
Madden MV, Krige JEJ, Bailey S, Beningfield SJ, Geddes C, Werner ID, Terblanche J: Randomized trial of targeted chemotherapy with lipiodol and 5-epidoxorubicin compared with symptomatic treatment for hepatoma. Gut 34:1598–1600, 1993
Horiguchi Y, Sekoguchi B, Imai H, Suzuki T, Kubo H, Itoh M: Treatment of choice for unresectable small liver cancer: Percutaneous ethanol injection therapy or transarterial chemoembolization therapy. Cancer Chemother Pharmacol 33(Suppl):S111-S114, 1994
Hashimoto T, Mitani T, Nakamura H, Hori S, Kozuka T, Kobayashi Y, Nakata A, Tsujimura T: Fatal septic complication of transcatheter chemoembolisation for hepatocellular carcinoma. Cardiovasc Intervent Radiol 16:325–327, 1993
Kalayci C, Johnson PJ, Raby N, Metivier EM, Williams R: Intraarterial adriamycin and lipiodol for inoperable hepatocellular carcinoma: A comparison with intravenous adriamycin. J Hepatol 11:349–353, 1990
Johnson PJ, Kalayci C, Dobbs N, Raby N, Metivier EM, Summers L, Harper P, Williams R: Pharmakokinetics and toxicity of intraarterial Adriamycin for hepatocellular carcinoma: Effect of coadministration of lipiodol. J Hepatol 1:120–1271, 1991
Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R: Transsection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649, 1973
Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H, Nakajima Y, Ohnishi K: Natural history of hapatocellular carcinoma and prognosis in relation to treatment. Cancer 56:918–928, 1985
Farinati F, Salvagnini M, De Maria N, Fornasiero A, Chiaramonte M, Rossaro L, Naccarato R: Unresectable hepatocellular carcinoma: A prospective controlled trial with tamoxifen. J Hepatol 11:297, 1990
Nakamura H, Tanaka T, Hori S, Sawada S: Transcatheter embolisation of hepatocellular carcinoma: Assessment of efficacy in cases of resection following embolisation. Radiology 147:401–405, 1983
Morino M, Miglietta C, Grosso M, de Giuli M, Bismuth H: Preoperative chemoembolisation for hepatocellular carcinoma. Surg Oncol Suppl 3:91–93, 1993
Tanaka A, Kumada K, Yamaoka Y, Ozawa K: Combined transcatheter arterial embolisation and expanded liver resection for hepatocellular carcinoma with multiple intrahepatic metastasis. Am J Gastroenterol 87:1496–1498, 1992
Bismuth H, Morino M, Sherlock D, Castaing D, Miglietta C, Cauquil P, Roche A: Primary treatment of hepatocellular carcinoma by arterial chemoembolisation. Am J Surg 163:387–394, 1992
Rougier P, Roche A, Pelletier G, Ducreux M, Pignon JP, Etienne JP: Efficacy of chemoembolisation for hepatocellular carcinomas: Experience from the Gustave Roussy Institute and the Bicètre Hospital. J Surg Oncol Suppl 3:94–96, 1993
Franco D, Capusotti L, Smadja C, Bouzari H, Meakins J, Kemeny F, Grange D: Resection of hepatocellular carcinoma: Results in 72 European patients with cirrhosis. Gastroenterology 98:733–738, 1990
Vetter D, Wenger JJ, Bergier JM, Doffoel M, Bockel R: Transcatheter oily chemoembolisation in the management of advanced hepatocellular carcinoma in cirrhosis: Results of a western comparative study in 60 patients. Hepatology 13:427–433, 1991
Ebara M, Ohto M, Shinagawa T, Sugiura N, Kimura K, Matsutani S: Natural history of minute hepatocellular carcinoma smaller than three centimeters complicating cirrhosis. A study in 22 patients. Gastroenterology 90:289–298, 1986
Cottone M, Virdone R, Fusco G, Orlando A, Turri M, Catagirone M, Maringhini A, Sciarrino E, Demma I, Nicoli N, Tine F, Sammarco S, Pagliaro L: Asymptomatic hepatocellular carcinoma in Child's A cirrhosis. Gastroenterology 96:1566–1571, 1989
Calvet X, Bruix J, Brù C, Ginès P, Vilana R. Solè, del Carmen Ayuso M, Bruguera M, Rodes J: Natural history of hepatocellular carcinoma in Spain. J Hepatol 10:311–317, 1990
Bronowicki JP, Vetter D, Dumas F, Boudjema K, Bader R, Weiss AM, Wenger JJ, Boissel P, Bigard MA, Doffoel M: Trancatheter oily chemoembolization for hepatocellular carcinoma. Cancer 74:16–24, 1994
Elba S, Giannuzzi V, Misciagna G, Manghisi OG: Randomized controlled trial of tamoxifen versus placebo in operable hepatocellular carcinoma. Ital J Gastroenterol 26:66, 1994
Martines Cerezo FJ, Tomas A, Donoso L, Enriquez J, Guarner C, Balanzò J, Nogueras AM, Vilardell F: Controlled trial of tamoxifen in patients with advanced hepatocellular carcinoma. J Hepatol 20:702, 1994
Taniguchi K, Nakata K, Kato Y, Sato Y, Hamasaki K, Tsuruta S, Nagataki S: Treatment of hepatocellular carcinoma with transcatheter arterial embolization. Cancer 73:1341–1345, 1994
Khan KNA, Nakata K, Shima M, Kusumoto Y, Ishii N, Koji T, Nagataki S: Pancreatic tissue damage by transcatheter arterial embolisation for hepatoma. Dig Dis Sci 38:65–70, 1993
Megyesi C, Samols E, Marks V: Glucose tolerance and diabetes in chronic liver disease. Lancet 2:1051–1057, 1967
Yki-Jarvinen H, Sammalkorpi K, Koivisto VA, Nikkila EA: Severity, duration and mechanisms of insulin resistance during acute infections. J Clin Endocrinol Metab 69:317–323, 1989
Takayasu K, Shima Y, Muramatsu Y, Moriyama N, Yamada T, Makuuchi H, Hasegawa H: Hepatocellular carcinoma: treatment with intraarterial iodized oil with and without chemotherapeutic agents. Radiology 162:345–351, 1987
Yamashita Y, Takahashi M, Koga Y, Saito R, Nanakawa S, Hatanaka Y, Sato N: Prognostic factors in the treatment of hepatocellular carcinoma with transcatheter arterial embolization and arterial infusion. Cancer 67:385–391, 1991
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Farinati, F., De Maria, N., Marafin, C. et al. Unresectable hepatocellular carcinoma in cirrhosis. Digest Dis Sci 41, 2332–2339 (1996). https://doi.org/10.1007/BF02100123
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02100123