title: Chemoembolization for the treatment of large hepatocellular carcinoma.
abstract: OBJECTIVE
  To retrospectively evaluate the efficacy of chemoembolization for inoperable hepatocellular carcinoma (HCC) tumors larger than 5 cm in diameter.
  
  
  METHODS
  Chemoembolization was performed in 30 patients with HCCs with a largest diameter of more than 5 cm with three or fewer lesions and no portal vein tumor thrombus. The mean maximum tumor diameter was 7.7 cm +/- 2.4. When the tumor was extremely large and had multiple feeding arteries, stepwise chemoembolization sessions at intervals of 3-10 weeks were performed. In addition, extrahepatic collateral supply was identified and embolized. Local therapeutic effects, survival rates, and complications were analyzed.
  
  
  RESULTS
  The mean follow-up period was 33.8 months +/- 24.1. One to 13 chemoembolization sessions (mean, 4.0 sessions +/- 3.0) were performed in each patient. Additionally, 62 collateral vessels were embolized in 21 patients, including 22 vessels in 14 patients at the initial procedure. Early tumor response rate 2-3 months after treatment was 43.3% by Response Evaluation Criteria In Solid Tumors. Complete radiologic response was achieved in 19 patients. Eleven patients died between 4 and 61 months after treatment (mean, 27.2 months +/- 21.8), including four deaths unrelated to hepatic causes. Nineteen patients have survived for 6-103 months (mean, 37.5 months +/- 25.2). Overall and progression free-survival rates at 1, 3, and 6 years were 82.3% and 66.0%, 73.9% and 57.6%, and 32.9% and 34.2%, respectively. Three infectious complications developed and were managed by interventions.
  
  
  CONCLUSIONS
  Chemoembolization was effective for large HCCs, although there is a risk of infectious complications after the procedure.
authors.affiliation: Dpeartment of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1 Funabashi, Wadanakacho, Fukui 918-8503, Japan. s-miyayama@fukui.saiseikai.or.jp
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyayama
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamashiro
authors.forename: Miho
authors.initials: M
authors.lastname: Okuda
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yoshie
authors.forename: Natsuki
authors.initials: N
authors.lastname: Sugimori
authors.forename: Saya
authors.initials: S
authors.lastname: Igarashi
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Nakashima
authors.forename: Kazuo
authors.initials: K
authors.lastname: Notsumata
authors.forename: Daisyu
authors.initials: D
authors.lastname: Toya
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Tanaka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mitsui
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D003097:Collateral Circulation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome