title: Efficacy of transarterial targeted treatments on survival of patients with hepatocellular carcinoma. An Italian experience.
abstract: BACKGROUND
  Most patients with hepatocellular carcinoma (HCC) are not suitable for surgical therapy. Systemic chemotherapy, immunotherapy, and hormonotherapy 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.
authors.affiliation: Istituto di Patologia Medica I, Università di Bologna, Italy.
authors.forename: G F
authors.initials: GF
authors.lastname: Stefanini
authors.forename: P
authors.initials: P
authors.lastname: Amorati
authors.forename: M
authors.initials: M
authors.lastname: Biselli
authors.forename: F
authors.initials: F
authors.lastname: Mucci
authors.forename: A
authors.initials: A
authors.lastname: Celi
authors.forename: V
authors.initials: V
authors.lastname: Arienti
authors.forename: R
authors.initials: R
authors.lastname: Roversi
authors.forename: C
authors.initials: C
authors.lastname: Rossi
authors.forename: G
authors.initials: G
authors.lastname: Re
authors.forename: G
authors.initials: G
authors.lastname: Gasbarrini
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D016022:Case-Control Studies; D002406:Catheterization, Peripheral; D002423:Cause of Death; D016461:Chemoembolization, Therapeutic; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007269:Injections, Intra-Arterial; D007459:Iodized Oil / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D007558:Italy; D008113:Liver Neoplasms / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016019:Survival Analysis
chemical_list: D007459:Iodized Oil