title: Comparison between chemoembolization combined with radiotherapy and chemoembolization alone for large hepatocellular carcinoma.
abstract: OBJECTIVE
  To investigate the efficacy of transcatheter arterial chemoembolization (TACE) combined with radiotherapy for unresectable large hepatocellular carcinoma (HCC).
  
  
  METHODS
  From June 1994 to June 1999, a total of 76 patients with large unresectable HCC were treated with TACE followed by external-beam irradiation. 89 patients with large HCC, who underwent TACE alone during the same period, served as the control group. Clinical features, therapeutic modalities, acute effects and survival rates were analyzed and compared between TACE plus irradiation group and TACE alone group. A multivariate analysis of nine clinical variables and one treatment variable (irradiation) was performed by the Cox proportional hazards model.
  
  
  RESULTS
  The clinical features and therapeutic modalities except irradiation between the two groups were comparable (P>0.05). The objective response rate (RR) in TACE plus irradiation group was higher than that in TACE alone group (47.4 % vs 28.1 %, P<0.05). The overall survival rates in TACE plus irradiation group (64.0 %, 28.6 %, and 19.3 % at 1, 3, 5 years, respectively) were significantly higher than those in TACE alone group (39.9 %, 9.5 %, and 7.2 %, respectively, P=0.0001). Cox proportional hazards model analysis showed that tumor extension and Child grade were significant and were independent negative predictors of survival, while irradiation was an independent positive predictor of survival.
  
  
  CONCLUSIONS
  TACE combined with radiotherapy is more effective than TACE alone, and is a promising treatment for unresectable large HCC.
authors.affiliation: Department of Oncology, Xinhua Hospital of Shanghai Second Medical University, 1665 Kongjiang Road, Shanghai 200092, China. guoweijian1@sohu.com
authors.forename: Wei-Jian
authors.initials: WJ
authors.lastname: Guo
authors.forename: Er-Xin
authors.initials: EX
authors.lastname: Yu
authors.forename: Lu-Ming
authors.initials: LM
authors.lastname: Liu
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.forename: Zhen
authors.initials: Z
authors.lastname: Chen
authors.forename: Jun-Hua
authors.initials: JH
authors.lastname: Lin
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Meng
authors.forename: Yi
authors.initials: Y
authors.lastname: Feng
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000503:physiopathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011878:Radiotherapy; D016019:Survival Analysis