title: Transcatheter arterial chemoembolization as primary treatment for hepatocellular carcinoma.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) in Western populations has historically been associated with poor survival.
  
  
  METHODS
  In this study, we conducted a 7-year retrospective analysis of patients with HCC undergoing transcatheter arterial chemoembolization (TACE) at our institution and examined demographics, outcomes, and complications.
  
  
  RESULTS
  During the period of study, 39 patients (25 male [64%], mean age 58 [range 17 to 86]) underwent a total of 78 chemoembolization treatments. During the same time period, an additional 31 patients received supportive care only. The majority of patients had late stage disease (American Joint Committee on Cancer stage III, IVa, or IVb) with no statistical difference noted between the two groups (P = 0.2). However, patients receiving supportive care only had significantly worse hepatic dysfunction by Child's classification (P = 0.005). Twenty-nine patients (74%) had documented cirrhosis, with hepatitis C being the most common cause in 11 of 29 (38%). In patients undergoing TACE, overall actuarial survival was 35%, 20%, and 11% at 1, 2, and 3 years with a median survival of 9.2 months, significantly improved over the group receiving supportive care only (P < 0.0001). Median survival for the group receiving supportive care was less than 3 months. Neither age nor stage had a significant impact on survival. The most common complications of TACE included transient nausea, abdominal pain, vomiting, and fever.
  
  
  CONCLUSIONS
  TACE is a safe and effective therapeutic option for selected patients with HCC not amenable to surgical intervention.
authors.affiliation: Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-4753, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Rose
authors.forename: W C
authors.initials: WC
authors.lastname: Chapman
authors.forename: A T
authors.initials: AT
authors.lastname: Brockenbrough
authors.forename: J K
authors.initials: JK
authors.lastname: Wright
authors.forename: A T
authors.initials: AT
authors.lastname: Rose
authors.forename: S
authors.initials: S
authors.lastname: Meranze
authors.forename: M
authors.initials: M
authors.lastname: Mazer
authors.forename: T
authors.initials: T
authors.lastname: Blair
authors.forename: C D
authors.initials: CD
authors.lastname: Blanke
authors.forename: J P
authors.initials: JP
authors.lastname: Debelak
authors.forename: C W
authors.initials: CW
authors.lastname: Pinson
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D002404:Catheterization; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology