title: Triple-drug transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma: assessment of survival in 124 consecutive patients.
abstract: OBJECTIVE
  The objective of our study was to describe survival outcome in 124 patients with unresectable hepatocellular carcinoma treated with triple-drug transcatheter arterial chemoembolization (TACE) using doxorubicin, cisplatin, and mitomycin C using a standardized regimen.
  
  
  METHODS
  One hundred twenty-four patients underwent TACE using a standardized triple-drug regimen. Embolization was performed using subselective coaxial embolization technique. Fifty-six patients (group 1) received triple-drug TACE in conjunction with a nonpermanent embolic agent, microfibrillar collagen (Avitene), and 68 patients (group 2) had triple-drug TACE with a permanent embolic agent, Embosphere Microspheres.
  
  
  RESULTS
  Twenty-eight patients underwent liver transplantation after TACE, and survival in these patients was significantly longer than those who did not receive a transplant (p < or = 0.001). The mean survival for the no-transplant group (n = 96) was longer in patients with Child-Pugh class A cirrhosis than in those with Child-Pugh class B cirrhosis (30.3 +/- 2.92 [standard error] vs 11.6 +/- 2.84 months, respectively; p < 0.001), in those with Okuda stage I versus stage II disease (31.4 +/- 3.03 vs 17.4 +/- 3.16 months; p = 0.002), and in those with a pre-TACE bilirubin level of less than 2.5 mg/dL (42.75 micromol/L; 28.3 +/- 2.75 vs 13.2 +/- 3.83 months; p = 0.007). Improved survival was seen in the no-transplant patients receiving TACE with the permanent embolic agent (group 2) than in those receiving TACE with the nonpermanent agent (group 1) out to 30 months (p = 0.002). Complications occurred in 16 patients (12.9%). The 30-day mortality was 2.4%.
  
  
  CONCLUSIONS
  Patients with hepatocellular carcinoma who underwent triple-drug TACE followed by liver transplantation showed the longest survival. Patients who did not receive a transplant and were treated with triple-drug TACE with a permanent embolic agent showed longer survival to 30 months after TACE than those receiving a nonpermanent embolic agent.
authors.affiliation: Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7437, USA. agomes@mednet.ucla.edu
authors.forename: Antoinette S
authors.initials: AS
authors.lastname: Gomes
authors.forename: Michael H
authors.initials: MH
authors.lastname: Rosove
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Rosen
authors.forename: Rafael G
authors.initials: RG
authors.lastname: Amado
authors.forename: James W
authors.initials: JW
authors.lastname: Sayre
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Monteleone
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D000180:Acrylic Resins / Q000008:administration & dosage; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D003094:Collagen / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005780:Gelatin / Q000008:administration & dosage; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000628:therapy*; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D016016:Proportional Hazards Models; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000180:Acrylic Resins; C496735:trisacryl gelatin microspheres; D016685:Mitomycin; D004317:Doxorubicin; D005780:Gelatin; D003094:Collagen; D002945:Cisplatin