title: Nonresectable hepatocellular carcinoma: long-term toxicity in patients treated with transarterial chemoembolization--single-center experience.
abstract: OBJECTIVE
  To determine the toxicity profile of transarterial chemoembolization (TACE) at 6 months and 1 year after treatment in patients with hepatocellular carcinoma (HCC) in a standardized oncology protocol so that TACE could be compared with systemic chemotherapeutic regimens for liver cancer.
  
  
  METHODS
  The study was authorized by the institutional review board. Between January 2002 and January 2007, 190 patients (155 men, 35 women; median age, 65 years; age range, 18-84 years) with HCC who underwent TACE treatment were identified from a prospectively collected database. Clinical records of complete blood cell counts and chemical profiles at baseline and at 6 and 12 months after treatment were studied retrospectively. Toxicity was graded according to the common terminology criteria for adverse events (CTCAE). A transition (survival) analysis perspective was used to estimate the distribution of toxicity grades. Patient survival from the first TACE session was calculated with Kaplan-Meier analysis.
  
  
  RESULTS
  Grade 3 or 4 toxicity 6 and 12 months, respectively, after treatment included leukocytopenia (7% and 19%); anemia (9% and 19%); thromobocytopenia (13% and 23%); prolonged activated partial thromboplastin time (8% and 18%); elevated aspartate aminotransferase (15% and 18%), alanine aminotransferase (10% and 18%), and alkaline phosphatase (8% and 18%) levels; hypoalbuminemia (10% and 19%); hyperbilirubinemia (10% and 22%); and alopecia (18%). The cumulative survival rate was 58% at 1 year, 39% at 2 years, and 29% at 3 years. These toxicity rates were considerably lower than those reported after treatment with currently used systemic chemotherapeutic agents.
  
  
  CONCLUSIONS
  Study results show that TACE has a favorable long-term toxicity profile in patients with HCC. Data clearly support the role of TACE in the treatment of patients with nonresectable HCC.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Johns Hopkins Hospital, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287, USA.
authors.forename: Manon
authors.initials: M
authors.lastname: Buijs
authors.forename: Josephina A
authors.initials: JA
authors.lastname: Vossen
authors.forename: Constantine
authors.initials: C
authors.lastname: Frangakis
authors.forename: Kelvin
authors.initials: K
authors.lastname: Hong
authors.forename: Christos S
authors.initials: CS
authors.lastname: Georgiades
authors.forename: Yong
authors.initials: Y
authors.lastname: Chen
authors.forename: Eleni
authors.initials: E
authors.lastname: Liapi
authors.forename: Jean-François H
authors.initials: JF
authors.lastname: Geschwind
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D000505:Alopecia / Q000139:chemically induced; D000740:Anemia / Q000139:chemically induced; D001219:Aspartate Aminotransferases / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced; D034141:Hypoalbuminemia / Q000139:chemically induced; D007970:Leukopenia / Q000139:chemically induced; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D012189:Retrospective Studies; D015996:Survival Rate; D013921:Thrombocytopenia / Q000139:chemically induced
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase
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