Sequential transarterial chemoembolization and percutaneous acetic acid injection therapy versus repeated percutaneous acetic acid injection for unresectable hepatocellular carcinoma: a prospective study.
BACKGROUND
Transarterial chemoembolization (TACE) and percutaneous acetic acid injection (PAI) are effective treatments for hepatocellular carcinoma (HCC). We have conducted a prospective study to compare the efficacy of sequential TACE and PAI (TACE-PAI) versus repeated PAI therapy for HCC.


METHODS
A total of 108 HCC patients with tumor size </=5 cm were enrolled. Fifty-three patients were treated with TACE-PAI and 55 patients were treated with PAI alone.


RESULTS
Objective responses were achieved in 72 of 80 nodules (90%) in the TACE-PAI group compared with 51 of 62 nodules (82%) in the PAI group (P = 0.217) during 24 +/- 10 months of follow-up. Patients in the TACE-PAI group had a significantly lower cumulative tumor recurrence rate from the treated nodule (P = 0.004) or newly developed tumor elsewhere in liver (P = 0.010). Complete tumor necrosis in large (3-5 cm) HCCs was more frequently encountered in the TACE-PAI group (64% versus 37%; P = 0.034). There was no significant survival difference between the two groups with small (</=3 cm) HCC (P = 0.569), whereas PAI therapy was an independent poor prognostic predictor [relative risk 3.0 (95% confidence interval 1.2-7.6); P = 0.017] in the large HCC group.


CONCLUSIONS
Sequential therapy with TACE and PAI is superior to repeated PAI alone for patients with large HCC.
Huo
T-I
TI
Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China. tihuo@vghtpe.gov.tw
Huang
Y-H
YH
Wu
J-C
JC
Chiang
J-H
JH
Lee
P-C
PC
Chang
F-Y
FY
Lee
S-D
SD
D019342:Acetic Acid / Q000008:administration & dosage*; D000279:Administration, Cutaneous; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D019342:Acetic Acid