Chemoembolization versus chemotherapy in elderly patients with unresectable hepatocellular carcinoma and contrast uptake as prognostic factor.
BACKGROUND
Age is considered one of the important contraindications to surgery for hepatocellular carcinoma (HCC) in cirrhosis patients. We therefore evaluated the safety and prevalence of side effects in endoarterial therapy (EAT) in subjects aged over 65 years compared with younger treated patients.


METHODS
Thirty-eight patients with HCC aged 65 years and over underwent transcatheter arterial chemoembolization (TACE) (n = 28) or intraarterial chemotherapy (IAC) (n = 10). The survival rate was calculated using Kaplan-Meier's method with respect to a control group consisting of younger treated subjects (44 TACE; 21 IAC) comparable for stage of HCC and severity of the underlying cirrhosis.


RESULTS
The comparison between the two groups regarding side effects, procedure-related death, and survival did not show any difference considering the whole EAT procedure. TACE in elderly subjects reached a statistically lower outcome with respect to younger patients (p < .025) but remained statistically superior in survival versus both older and younger patients treated with IAC (p < .05, respectively). Stratifying the patients following the degree of Lipiodol uptake of tumor mass in the three groups (Group I, > 75%; Group II, 50-75%; Group III, < 50%), in the young subjects a higher probability of survival was strictly correlated to a degree of uptake over 75%, while in the elderly patients an impregnation over 50% was sufficient to obtain a satisfactory survival curve.


CONCLUSIONS
EAT is a reliable and safe therapeutic option for the geriatric patient with HCC, with TACE showing a better efficacy than IAC, requiring a lesser degree of Lipiodol uptake to achieve an improvement of outcome.
Biselli
M
M
G. Fontana Center for the Multidisciplinary Study and Treatment of Alcohol Abuse, University of Bologna, Italy.
Forti
P
P
Mucci
F
F
Foschi
F G
FG
Marsigli
L
L
Caputo
F
F
Ravaglia
G
G
Bernardi
M
M
Stefanini
G F
GF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003287:Contrast Media / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007459:Iodized Oil / Q000493:pharmacokinetics*; D008113:Liver Neoplasms / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate
D003287:Contrast Media; D007459:Iodized Oil