The long term efficacy of combined transcatheter arterial embolization and percutaneous ethanol injection in the treatment of patients with large hepatocellular carcinoma and cirrhosis.
BACKGROUND
The long term efficacy of combination therapy with transcatheter arterial embolization (TAE) followed by percutaneous ethanol injection (PEI) was studied in patients with large primary hepatocellular carcinoma (HCC) tumors and cirrhosis.


METHODS
The series included 83 patients with large unresectable HCC lesions, the largest of which was greater than 3 cm in largest dimension. Fifty-five had a solitary lesion and 28 had multiple (2 or 3) lesions. All patients were treated with both TAE and PEI and their survival rates were determined.


RESULTS
The 3-, 5-, and 7-year calculated survival rates for the patients were be 68%, 35%, and 14%, respectively. The number of lesions (solitary vs. multiple), the stage of cirrhosis (Child's Class A vs. Class B or C), and the size of the largest lesion (3-5 cm in largest dimension compared with > 5 cm) significantly affected the survival rate (P < 0.05 to P < 0.01, log rank test). The 3-, 5-, and 7-year survival rates of the Child's Class A patients who had a 3-5 cm solitary lesion (n = 22) were 100%, 75%, and 27%, respectively. The Cox proportional hazards model showed the stage of cirrhosis and size of the largest lesion to be independently associated with survival. No serious complications occurred during or after treatment.


CONCLUSIONS
Combination therapy with TAE and PEI is an effective and safe treatment that may improve the long term survival of patients with cirrhosis associated with large HCC lesions, and survival after this combination therapy may be comparable to that after surgery.
Tanaka
K
K
Third Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
Nakamura
S
S
Numata
K
K
Kondo
M
M
Morita
K
K
Kitamura
T
T
Saito
S
S
Kiba
T
T
Okazaki
H
H
Sekihara
H
H
D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D002406:Catheterization, Peripheral; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D015251:Epirubicin / Q000008:administration & dosage / Q000627:therapeutic use; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use; D006499:Hepatic Artery; D006801:Humans; D015552:Injections, Intralesional; D007459:Iodized Oil; D008103:Liver Cirrhosis / Q000145:classification / Q000601:surgery / Q000628:therapy*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012449:Safety; D012997:Solvents / Q000008:administration & dosage / Q000627:therapeutic use; D015996:Survival Rate
D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D003287:Contrast Media; D012997:Solvents; D000431:Ethanol; D015251:Epirubicin; D007459:Iodized Oil; D004317:Doxorubicin