Chemoembolization of hepatocellular carcinoma with cisplatin, doxorubicin, mitomycin-C, ethiodol, and polyvinyl alcohol: prospective evaluation of response and survival in a U.S. population.
OBJECTIVE
To evaluate response and survival after hepatic chemoembolization with cisplatin, doxorubicin, mitomycin-C, Ethiodol, and polyvinyl alcohol in a U.S. population of patients with hepatocellular carcinoma.


METHODS
Thirty-eight consecutive patients were treated: 35% stage I, 62% stage II, 3% stage III. Fifty-one percent had cirrhosis. Chemoembolization was performed at approximately monthly intervals for one to seven sessions (mean, 2.2). Pretreatment and posttreatment cross-sectional imaging and alpha-fetoprotein (AFP) levels were obtained prospectively 1 month after treatment and then every 3 months. Thirty-day response was calculated by means of the the World Health Organization/Eastern Cooperative Oncology Group criteria.


RESULTS
One patient was lost to follow-up. In seven patients, lesions became resectable after chemoembolization. Among 13 evaluable patients with initially elevated AFP level, 70% had a partial biologic response (>50% decrease in AFP), 15% had a minor response (25-50% decrease), and the remaining 15% remained stable. Among 25 patients evaluable for morphologic response, 36% had a partial response, 32% had a minor response, and 32% remained stable. No patients had progression of disease while receiving therapy. The cumulative survival was 60% at 1 year, 41% at 2 years, and 16% at 3 years. Two patients developed progressive hepatic failure. Thirty-day mortality was 3% (one patient).


CONCLUSIONS
These results compare favorably to published response and survival data for chemoembolization of advanced hepatocellular carcinoma from Asia and Europe.
Solomon
B
B
Division of Interventional Radiology, University of Pennsylvania, Philadelphia 19104, USA.
Soulen
M C
MC
Baum
R A
RA
Haskal
Z J
ZJ
Shlansky-Goldberg
R D
RD
Cope
C
C
D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D017093:Liver Failure / Q000209:etiology; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage; D009367:Neoplasm Staging; D011142:Polyvinyl Alcohol / Q000008:administration & dosage; D011446:Prospective Studies; D012074:Remission Induction; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014481:United States; D000509:alpha-Fetoproteins / Q000032:analysis
D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D000509:alpha-Fetoproteins; D016685:Mitomycin; D004998:Ethiodized Oil; D004317:Doxorubicin; D011142:Polyvinyl Alcohol; D002945:Cisplatin