Nonresectable hepatocellular carcinoma: long-term toxicity in patients treated with transarterial chemoembolization--single-center experience.
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.
Buijs
Manon
M
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.
Vossen
Josephina A
JA
Frangakis
Constantine
C
Hong
Kelvin
K
Georgiades
Christos S
CS
Chen
Yong
Y
Liapi
Eleni
E
Geschwind
Jean-François H
JF
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
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase
Cancer. 2000 Jan 1;88(1):50-7
10618605
J Vasc Interv Radiol. 2005 Dec;16(12):1653-9
16371532
Am J Pathol. 1954 Sep-Oct;30(5):969-77
13197542
Hepatology. 2002 May;35(5):1164-71
11981766
J Hepatol. 1990 Sep;11(2):181-4
2174933
N Engl J Med. 1999 Mar 11;340(10):745-50
10072408
Eur J Radiol. 2006 Sep;59(3):407-12
16621394
Radiology. 2002 Jul;224(1):47-54
12091661
Hepatology. 2002 Mar;35(3):519-24
11870363
Hepatology. 1998 Sep;28(3):751-5
9731568
Am J Gastroenterol. 2007 Aug;102(8):1661-70; quiz 1660, 1671
17555459
Cancer. 1996 Jun 1;77(11):2217-22
8635087
Gastroenterology. 2004 Nov;127(5 Suppl 1):S218-24
15508087
J Clin Gastroenterol. 2002 Nov-Dec;35(5 Suppl 2):S109-14
12394214
Hepatology. 1998 Jun;27(6):1578-83
9620330
Ann Oncol. 1997 Feb;8(2):117-36
9093719
Hepatogastroenterology. 2003 Jan-Feb;50(49):183-7
12630019
Support Care Cancer. 2003 Jun;11(6):371-7
12768403
Jpn J Clin Oncol. 2002 Nov;32(11):455-60
12499417
Hepatol Res. 2007 Sep;37 Suppl 2:S88-94
17877502
Cancer Epidemiol Biomarkers Prev. 2006 Jun;15(6):1198-203
16775181
Acta Oncol. 2001;40(2-3):175-84
11441930
J Vasc Interv Radiol. 2006 Jan;17(1):47-53
16415132
J Clin Oncol. 2006 Sep 10;24(26):4293-300
16908937
Radiology. 1996 Jan;198(1):33-40
8539401
Lancet. 2002 May 18;359(9319):1734-9
12049862
Am J Clin Oncol. 2003 Aug;26(4):344-9
12902882
Radiology. 2000 Apr;215(1):123-8
10751477
Semin Radiat Oncol. 2003 Jul;13(3):176-81
12903007
Semin Oncol. 2001 Oct;28(5):503-13
11685743
Cancer. 1988 Aug 1;62(3):479-83
2839280
Int J Cancer. 2001 Oct 15;94(2):153-6
11668491
Cancer. 1994 Jul 1;74(1):16-24
7516263