title: Chemoembolization for hepatocellular carcinoma: comprehensive imaging and survival analysis in a 172-patient cohort.
abstract: 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.
authors.affiliation: 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.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Laura M
authors.initials: LM
authors.lastname: Kulik
authors.forename: Ahsun
authors.initials: A
authors.lastname: Riaz
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Talia B
authors.initials: TB
authors.lastname: Baker
authors.forename: Saad M
authors.initials: SM
authors.lastname: Ibrahim
authors.forename: Michael I
authors.initials: MI
authors.lastname: Abecassis
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
authors.forename: Seanthan
authors.initials: S
authors.lastname: Senthilnathan
authors.forename: Scott A
authors.initials: SA
authors.lastname: Resnick
authors.forename: Edward
authors.initials: E
authors.lastname: Wang
authors.forename: Ramona
authors.initials: R
authors.lastname: Gupta
authors.forename: Richard
authors.initials: R
authors.lastname: Chen
authors.forename: Steven B
authors.initials: SB
authors.lastname: Newman
authors.forename: Howard B
authors.initials: HB
authors.lastname: Chrisman
authors.forename: Albert A
authors.initials: AA
authors.lastname: Nemcek
authors.forename: Robert L
authors.initials: RL
authors.lastname: Vogelzang
authors.forename: Reed A
authors.initials: RA
authors.lastname: Omary
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: 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
chemical_list: D003287:Contrast Media