Efficacy of transarterial targeted treatments on survival of patients with hepatocellular carcinoma. An Italian Experience

Autor: Giuseppe Re, G. Francesco Stefanini, Paolo Amorati, Antonina Celi, Giovanni Gasbarrini, Rigoantonio Roversi, Maurizio Biselli, Cristina Rossi, Fabrizio Mucci, Vincenzo Arienti
Rok vydání: 1995
Předmět:
Zdroj: Cancer. 75:2427-2434
ISSN: 1097-0142
0008-543X
DOI: 10.1002/1097-0142(19950515)75:10<2427::aid-cncr2820751007>3.0.co;2-j
Popis: Background. Most patients with hepatocellular carcinoma (HCC) are not suitable for surgical therapy. Systemic chemotherapy, immunotherapy, and hormono-therapy have not had convincingly acceptable results. Therefore, transarterial catheter-targeted therapies such as intraarterial chemotherapy (IAC), possibly followed by transcatheter arterial chemoembolization (TACE), have been proposed. Methods. A survival analysis curve was drawn using the Kaplan-Meier method for 164 patients, 100 with HCC who underwent TACE (69) or IAC (31), and a matched historic group of 64 who did not receive specific antineoplastic treatment. Results. A significantly more favorable survival was observed for TACE-treated patients compared with IAC-treated patients (P < 0.001) ; TACE- and IAC-treated patients had a statistically superior survival than that of untreated patients (P < 0.001 and P < 0.025, respectively). This difference was still significant (P < 0.001) when the patients were subdivided into Classes A and B and Stages I and II following Child's and Okuda's criteria. The TACE- and IAC-treated groups had a good relationship between technical efficacy of therapy and survival. Stratifying the patients according to the degree of iodized oil (Lipiodol Ultrafluid, Guerbet, Aulnay-Sous-Bois, France) uptake in the three groups with Group 1 having an uptake greater than 75% of tumor mass, Group 2 having an uptake of 50%-75%, and Group 3 having an uptake less than 50%, survival at 6, 12, 24, 36, and 48 months was calculated as 94%, 88%, 67%, 53%, and 30%, respectively, for Group 1 ; 86%, 68%, 13%, 13%, and 0% for Group 2, and 43%, 23%, 6%, 6%, and 0% for Group 3 (Group 1 vs. Group 2 : P < 0.001 ; Group 1 vs. Group 3 : P < 0.001 ; Group 2 vs. Group 3 : P < 0.001, respectively). The most important side effects after the intraarterial procedure were fever (46.2%), abdominal pain (36.6%), chemical cholecystitis (8%), and pancreatitis (1.7%). Death strictly related to treatment occurred in two patients ; one had massive bleeding due to ruptured esophageal varices, and the other had a subphrenic abscess of a superficial HCC of the VIII segment. Conclusions. Transcatheter arterial chemoembolization and IAC were effective and relatively safe, and the authors believe that they have a primary role in treating patients with unresectable HCC larger than 5 cm ; iodized oil uptake can be considered a suitable prognostic marker. Cancer 1995 ;75 :2427-34.
Databáze: OpenAIRE
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