title: Hepatocellular carcinoma with internal mammary artery supply: feasibility and efficacy of transarterial chemoembolization and factors affecting patient prognosis.
abstract: OBJECTIVE
  To determine technical feasibility, therapeutic efficacies, and identify prognostic factors in patients with hepatocellular carcinoma (HCC) treated by transarterial chemoembolization via the internal mammary artery.
  
  
  METHODS
  From August 1996 to July 2005, the authors identified the internal mammary arteries supplying HCCs in 97 (2.2%) of 4,438 HCC patients. Computed tomography scans and digital subtraction angiography images of these 97 patients were retrospectively reviewed by consensus between two of the authors regarding technical success and clinical outcome. The technical success of internal mammary artery chemoembolization was defined as achievement of catheterization into feeding vessels, delivery of drugs via those vessels, and no residual tumor staining fed by the internal mammary artery. Multivariate Cox proportional hazard regression analysis was performed to enable evaluation of prognostic factors for survival.
  
  
  RESULTS
  Technical success by selective chemoembolization via internal mammary artery was achieved in 53 (55%) of the 97 patients. The clinical responses of the 97 patients were complete remission (n=3), partial remission (n=19), no response (n=65), and no available follow-up image (n=10). Overall cumulative survival rates, calculated from times of internal mammary artery chemoembolization, were 55.9% (at 6 months), 32.5% (at 1 year), 15.4% (at 2 years), and 8.2% (at 3 years). Multivariate analysis showed that tumor multiplicity (single vs multiple nodular or diffuse; P=.013), portal vein thrombosis (P=.004), and the technical success of internal mammary artery chemoembolization (P=.02) each significantly affected survival.
  
  
  CONCLUSIONS
  Although patients with HCC supplied by the internal mammary artery had poor prognosis because of their advanced stage of disease, chemoembolization via the internal mammary artery is possible and worth performing in selective situations.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hyo-Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Chung
authors.forename: Seung Hong
authors.initials: SH
authors.lastname: Choi
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Yoon
authors.forename: Hyo-Suk
authors.initials: HS
authors.lastname: Lee
authors.forename: Hwan Jun
authors.initials: HJ
authors.lastname: Jae
authors.forename: Whal
authors.initials: W
authors.lastname: Lee
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D004317:Doxorubicin / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000098:blood supply / Q000628:therapy*; D008297:Male; D008323:Mammary Arteries; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin