Indication of chemoembolization therapy without gelatin sponge for hepatocellular carcinoma.
This study evaluated the effect of chemoembolization (C-LIP) consisting of ethiodized oil (Lipiodol Ultra Fluid; André Guerbet, Aulnay-sous-Bois, France) and epirubicin, without gelatin sponge on hepatocellular carcinoma (HCC), administered by hepatic arterial infusion. We analyzed the cases from two points of view: the local recurrence rate for hypervascular solitary small HCC (tumor size: < or =3 cm in diameter) and the cumulative survival rate for advanced HCC (stage VI according to the criteria of Liver Cancer Group of Japan) following C-LIP therapy. The C-LIP also was compared with transcather arterial embolization (TAE; C-LIP followed by gelatin sponge) and percutaneous ethanol injection therapy (PEIT). In the small HCC cases, the recurrence rate at 1 year after C-LIP was 77% (10 of 13 patients), while the local recurrence rate was 46% (six of 13 patients) at 6 months and 61% (eight of 13 patients) at 1 year. The local recurrence rate at 1 year was 29% (four of 14 patients) after TAE and 20% (three of 15 patients) after PEIT. These results showed that the effect of local anticancer therapy by C-LIP was not as potent as that of TAE or PEIT. In advanced HCC cases, the cumulative survival rate for 13 patients treated by C-LIP was 72% at 6 months, 36% at 1 year, and 14% at 2 years. However, the survival rates for 13 patients at 6 months, 1 year, and 2 years after TAE were 46%, 23%, and 8%, respectively. There was no difference between the C-LIP patients and TAE patients with regard to the pretreatment liver function. Three patients died within 2 months after the initial TAE. These deaths were mainly due to damage to the noncancerous liver parenchyma. Therapy with C-LIP alone was not appropriate for hypervascular solitary small HCCs, and additional treatment was necessary. We think C-LIP therapy should be selected instead of TAE for advanced HCCs to avoid severe parenchymal damage.
Suzuki
M
M
Department of Internal Medicine, St Marianna University, Yokohama-shi Hospital, Yokohama, Japan.
Suzuki
H
H
Yamamoto
T
T
Mamada
Y
Y
Mizuno
H
H
Tominaga
T
T
Suga
M
M
Suemori
S
S
Kato
Y
Y
Sato
A
A
Yamanouchi
E
E
Sakuyama
K
K
Maeyama
S
S
Shinagawa
T
T
Okabe
K
K
D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D015251:Epirubicin / Q000008:administration & dosage; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D005781:Gelatin Sponge, Absorbable; D006801:Humans; D015552:Injections, Intralesional; D007459:Iodized Oil / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D015996:Survival Rate
D000903:Antibiotics, Antineoplastic; D000431:Ethanol; D015251:Epirubicin; D007459:Iodized Oil