Combined TACE and PEI for palliative treatment of unresectable hepatocellular carcinoma.
OBJECTIVE
To assess whether the effectiveness of a combination of transarterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) in the treatment of unresectable hepatocellular carcinoma (HCC) is superior to TACE alone a randomized controlled trial was performed.


METHODS
The effect of combination therapy on long-term survival rates and duration of hospitalization was evaluated in 52 previously untreated HCCs, randomly allocated to TACE-PEI (27 pts) or TACE alone (25 pts).


RESULTS
The cumulative survival rate of the TACE group was 75.8% at 6 mo, 62.9% at 12 mo, and 18.0% at 24 mo and of the TACE-PEI group 76.9%, 61.5%, and 38.7%, respectively. Comparison of overall survival in both groups showed no statistically significant difference. Regarding the patients with HCCs Okuda stage I (n = 26), the median survival of the TACE-PEI group was significantly longer (>24 mo, median not yet reached in the study period) compared to the TACE group (18.4 mo [range 11.6-21.7 mo]; P = 0.04). TACE-PEI reduced the relative risk for mortality to 0.4 (95%CI 0.15-0.96) compared to patients who received TACE alone. Median survival in patients with HCCs Okuda stage II or III was 5.0 mo in the TACE group (1.7 mo-not defined) compared to 10.4 mo in the TACE-PEI group.


CONCLUSIONS
The combination TACE-PEI improved survival time compared to TACE alone. Our study revealed a statistically significant improved survival in HCCs Okuda stage I. Side effects were minor and the combination therapy did not prolong duration of hospitalization considerably.
Becker
Gerhild
G
Hubert Erich Blum, Abteilung Innere Medizin II, Medizinische Universitatsklinik, Hugstetter Str. 55, D-79106 Freiburg, Germany.
Soezgen
Tarik
T
Olschewski
Manfred
M
Laubenberger
Joerg
J
Blum
Hubert Erich
HE
Allgaier
Hans-Peter
HP
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D012997:Solvents / Q000008:administration & dosage*; D015996:Survival Rate
D012997:Solvents; D000431:Ethanol