Embolization efficacy and treatment effectiveness of transarterial therapy for unresectable hepatocellular carcinoma: a case-controlled comparison of transarterial ethanol ablation with lipiodol-ethanol mixture versus transcatheter arterial chemoembolization.
OBJECTIVE
To compare the embolization efficacy and treatment effectiveness of transarterial ethanol ablation (TEA) versus those of chemoembolization and evaluate the correlation between embolization efficacy and treatment effectiveness of these treatments for hepatocellular carcinoma (HCC).


METHODS
A case-controlled study was undertaken with 30 patients in each group matched based on Child-Pugh grade, tumor characteristics, and performance status. Primary endpoints were embolization efficacy (ie, Lipiodol retention within tumor at 2 months) and treatment effectiveness as evaluated by tumor response, disease progression, progression-free survival, and overall survival. The secondary endpoint was correlation between embolization efficacy and treatment effectiveness.


RESULTS
Lipiodol retention was greater in the TEA group (89.5% +/- 10.7% vs 47.5% +/- 21.2%; P < .0001). The tumor progression rate at 1 year was higher in the chemoembolization group (five of 30 vs zero of 30; P = .0261). One- and 2-year overall survival rates were higher in the TEA group (93.3% and 80.0%, respectively, vs 73.3% and 43.3%, respectively; P = .0053). One- and 2-year extrahepatic disease progression rates were lower in the TEA group (P = .0002). There were no differences in progression-free survival and intrahepatic disease progression rates at 1 and 2 years. Patients with greater Lipiodol retention (ie, >60%) had better treatment outcomes at 1 year than those with lesser retention, with higher overall survival rates (88.9% vs 66.7%; P = .0192), lower intrahepatic disease progression rates (25.6% vs 59.4%; P = .0169), lower extrahepatic disease progression rates (0.31% vs 35.5%; P = .0047), and higher progression-free survival rates (72.1% vs 36.3%; P = .005).


CONCLUSIONS
The embolization efficacy and treatment effectiveness of TEA are probably superior to those of chemoembolization for HCC.
Yu
Simon C H
SC
Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. simonyu@cuhk.edu.hk
Hui
Joyce W Y
JW
Hui
Edwin P
EP
Mo
Frankie
F
Lee
Paul S F
PS
Wong
John
J
Lee
Kit F
KF
Lai
Paul B S
PB
Yeo
Winnie
W
D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000628:therapy*; D016022:Case-Control Studies; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007278:Injections, Spinal; D007459:Iodized Oil; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome
D003287:Contrast Media; D000431:Ethanol; D007459:Iodized Oil