Treatment of hepatocellular carcinoma using doxorubicin/ethiodized oil/gelatin powder chemoembolization.
BACKGROUND
Hepatocellular carcinoma (HCC) is a common malignancy worldwide with limited effective therapeutic options available or appropriate for cirrhotic patients.


METHODS
Chemoembolization, using sequential intra-arterial doxorubicin/ethiodized oil and gelatin sponge particle/ethanol embolization, was used to treat patients with unresectable HCC localized to the liver. Fifty-two patients were treated in this manner from 1988 to 1992. The objective response was determined by sequential computed tomography (CT) scans.


RESULTS
Of the 47 patients evaluable for response, 20 (43%) achieved a partial response, and 12 (26%) achieved a minor response. Sixteen patients underwent repeated chemoembolization for locally recurrent disease as many as three times after the initial procedure. All 52 patients were evaluable for survival and toxicity, with a median follow-up of 14 months. Twelve-month survival was 60%, and median survival was 16 months. This compares favorably with values reported in the literature of approximately 20% and 6-14 weeks, respectively. There was a 17% 30-day mortality, with a slightly higher risk for patients with portal vein obstruction. Other toxicities generally were mild and transient, including fever, pain, encephalopathy, and malaise.


CONCLUSIONS
Chemoembolization may enhance survival for patients with unresectable, localized HCC. It appears to be an effective alternative to standard treatment, even in cirrhotic patients.
Stuart
K
K
Department of Medicine, New England Deaconess Hospital, Harvard Medical School, Boston, MA 02215.
Stokes
K
K
Jenkins
R
R
Trey
C
C
Clouse
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D004317:Doxorubicin / Q000008:administration & dosage*; D004998:Ethiodized Oil / Q000008:administration & dosage*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage*; D006801:Humans; D007269:Injections, Intra-Arterial; D007902:Length of Stay; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care; D011379:Prognosis; D012074:Remission Induction; D015996:Survival Rate
D004998:Ethiodized Oil; D004317:Doxorubicin