Hepatic arterial chemoembolization for hepatocellular carcinoma: comparison of survival rates with different embolic agents.
OBJECTIVE
The optimal embolic agent for transhepatic arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) has not been identified. This study reports outcomes of TACE for HCC with Gelfoam powder and polyvinyl alcohol (PVA).


METHODS
Eighty-one patients underwent 152 TACE sessions with Gelfoam powder (n = 41) or polyvinyl alcohol (PVA) and Ethiodol (n = 40) as the embolic agent. Chemotherapeutic drugs were the same for all patients (50 mg cisplatin, 20 mg doxorubicin, 10 mg mitomycin-c). The groups were compared based on number of TACE sessions, maximum tumor size, bilirubin level, aspartate and alanine aminotransferase levels, Child-Pugh score, Model for End-stage Liver Disease score, and hepatitis B or C virus positivity. The number of cases of each Child class in each group was also evaluated. Survival starting from the first TACE session was calculated according to Kaplan-Meier analysis. Forty-eight patients died during the study period, 19 received transplants, and 14 were alive at the end of the study period.


RESULTS
The groups were statistically similar in all categories regarding liver function, Child-Pugh score, tumor size, hepatitis status, and percentage of patients with Child class A, B, and C disease. The number of TACE sessions was significantly greater for the Gelfoam powder group (mean, 2.2) versus the PVA group (mean, 1.6; P = .01). Overall survival was similar between groups whether patients who received transplants were included in the analysis (mean, 659 days +/- 83 with Gelfoam powder vs 565 days +/- 71 with PVA; P = .42) or were excluded (mean, 519 days +/- 80 with Gelfoam powder vs 511 days +/- 75 with PVA; P = .93).


CONCLUSIONS
In similar patient groups, survival after treatment of HCC with TACE with Gelfoam powder or PVA and Ethiodol was similar.
Brown
Daniel B
DB
Mallinckrodt Institute of Radiology, Washington University Medical Center, 510 South Kingshighway Boulevard, St. Louis, Missouri 63110, USA. brownda@mir.wustl.edu
Pilgram
Thomas K
TK
Darcy
Michael D
MD
Fundakowski
Christopher E
CE
Lisker-Melman
Mauricio
M
Chapman
William C
WC
Crippin
Jeffrey S
JS
D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage*; D006490:Hemostatics / Q000008:administration & dosage*; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D016685:Mitomycin / Q000008:administration & dosage; D011142:Polyvinyl Alcohol / Q000008:administration & dosage*; D011208:Powders; D015641:Radiography, Interventional; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D006490:Hemostatics; D011208:Powders; D016685:Mitomycin; D004998:Ethiodized Oil; D004317:Doxorubicin; D011142:Polyvinyl Alcohol; D002945:Cisplatin