Chemoembolization for hepatocellular carcinoma: comprehensive imaging and survival analysis in a 172-patient cohort.
OBJECTIVE
To determine comprehensive imaging and long-term survival outcome following chemoembolization for hepatocellular carcinoma (HCC).


METHODS
One hundred seventy-two patients with HCC treated with chemoembolization were studied retrospectively in an institutional review board approved protocol; this study was HIPAA compliant. Baseline laboratory and imaging characteristics were obtained. Clinical and laboratory toxicities following treatment were assessed. Imaging characteristics following chemoembolization were evaluated to determine response rates (size and necrosis) and time to progression (TTP). Survival from the time of first chemoembolization treatment was calculated. Subanalyses were performed by stratifying the population according to Child-Pugh, United Network for Organ Sharing, and Barcelona Clinic for Liver Cancer (BCLC) staging systems.


RESULTS
Cirrhosis was present in 157 patients (91%); portal hypertension was present in 139 patients (81%). Eleven patients (6%) had metastases at baseline. Portal vein thrombosis was present in 11 patients (6%). Fifty-five percent of patients experienced some form of toxicity following treatment; 21% developed grade 3 or 4 bilirubin toxicity. Post-chemoembolization response was seen in 31% and 64% of patients according to size and necrosis criteria, respectively. Median TTP was 7.9 months (95% confidence interval: 7.1, 9.4) but varied widely by stage. Median survival was significantly different between patients with BCLC stages A, B, and C disease (stage A, 40.0 months; B, 17.4 months; C, 6.3 months; P < .0001).


CONCLUSIONS
The determination of TTP and survival in patients with HCC is confounded by tumor biology and background cirrhosis; chemoembolization was shown to be a safe and effective therapy in patients with HCC.
Lewandowski
Robert J
RJ
Dept of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Ctr, Northwestern Memorial Hosp, 676 N St Clair St, Suite 800, Chicago, IL 60611, USA.
Mulcahy
Mary F
MF
Kulik
Laura M
LM
Riaz
Ahsun
A
Ryu
Robert K
RK
Baker
Talia B
TB
Ibrahim
Saad M
SM
Abecassis
Michael I
MI
Miller
Frank H
FH
Sato
Kent T
KT
Senthilnathan
Seanthan
S
Resnick
Scott A
SA
Wang
Edward
E
Gupta
Ramona
R
Chen
Richard
R
Newman
Steven B
SB
Chrisman
Howard B
HB
Nemcek
Albert A
AA
Vogelzang
Robert L
RL
Omary
Reed A
RA
Benson
Al B
AB
Salem
Riad
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D003287:Contrast Media