Treatment of large hepatocellular carcinoma: comparison between techniques and long term results.
OBJECTIVE
The aim of this study was to compare results over time of Transcatheter Arterial Chemo Embolization (TACE), Percutaneous Ethanol Injection (PEI), Laser Thermal Ablation (LTA) and combined therapy of large Hepatocellular Carcinoma (HCC).


METHODS
Between 1995 and 2003, 89 cirrhosis patients (51 Child-Pugh A, 38 Child-Pugh B) with at least one nodule of HCC =/> 40 mm, were included in this randomized study; 21 were treated with TACE, 20 with PEI, 29 with LTA and 19 with combined therapy. The total number of HCC nodules was 92 with a mean diameter of 52.9 mm.


RESULTS
No major complication occurred in all procedures. CT scan showed that complete necrosis was achieved in 83% of treated nodules (76 out of 92); as a whole, the disease relapsed in 18 (20.2%) patients (disease free interval being 18.2+/-9.4 months). The cumulative survival rates were 69.6%, 25.1% and 9.8% at 12, 36 and 60 months respectively. Univariate analysis of survival showed statistically significant differences in the comparison between Child-Pugh A group vs B (p<0.0001) and between single nodule vs multiple (p=0.0019). Patients subjected to combined therapy and LTA showed a statistically significant longer survival than those treated with TACE and PEI.


CONCLUSIONS
LTA proves to be the most effective treatment for HCC < 50 mm, combined therapy is the best choice for nodules =/> 50 mm since complete necrosis is achieved in almost all cases and better total survival in the treated patients.
Ferrari
Francesco Saverio
FS
Dipartimento di Scienze Ortopedico-Riabilitative, Radiologiche e Otorinolaringoiatriche DAI dell'immagine, Azienda Ospedaliera Senese, Policlinico Le Scotte, Siena, Italy.
Stella
Andrea
A
Gambacorta
Daniela
D
Magnolfi
Fabrizio
F
Fantozzi
Federica
F
Pasquinucci
Paolo
P
Civeli
Letizia
L
Pieraccini
Massimo
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D017075:Laser Coagulation; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015996:Survival Rate
D000431:Ethanol