title: Transarterial chemoembolization with cisplatin as second-line treatment for hepatocellular carcinoma unresponsive to chemoembolization with epirubicin-Lipiodol emulsion.
abstract: OBJECTIVE
  The purpose of this retrospective study was to investigate the efficacy of transarterial chemoembolization (TACE) using cisplatin as a second-line treatment for advanced hepatocellular carcinoma (HCC) unresponsive to TACE using epirubicin-Lipiodol emulsion at our institution.
  
  
  METHODS
  Between January 2006 and March 2009, 51 patients with unresectable HCC underwent TACE using cisplatin. All patients had shown persistent viable tumor or tumor progression after at least 2 sessions of TACE using epirubicin-Lipiodol emulsion. TACE procedures consisted of arterial injection of a mixture of Lipiodol and cisplatin (30-100 mg [mean 57 ± 21]) (n = 29) or arterial infusion of cisplatin (30-100 mg [mean 87 ± 19]) solution (n = 22) followed by injection of 1-mm porous gelatin particles. Early tumor response was assessed by contrast-enhanced computed tomography (CT) according to Response Evaluation Criteria in Solid Tumors (RECIST) and European Association for the Study of the Liver (EASL) criteria. Overall survival and progression-free survival was calculated using the Kaplan-Meier method. Toxicity was assessed according to NCI-CTCAE version 3 criteria.
  
  
  RESULTS
  Response rates were 11.8 and 27.5% by RECIST and EASL criteria, respectively. Overall survival rates were 61.9, 48.2, and 28.9% at 1, 2, and 3 years, respectively, and the median survival time was 15.4 months. Progression-free survival rate was 35.2% at 1 year, and median progression-free survival time was 3.1 months. No major complications were observed, and the occurrence of postembolization syndrome was minimal. Grade 3 to 4 toxicities included thrombocytopenia (5.8%), increased aspartate aminotransferase (AST) level (35.3%), and increased alanine aminotransferase (ALT) level (23.5%).
  
  
  CONCLUSIONS
  Switching the TACE anticancer drug from epirubicin to cisplatin might be the feasible option for advanced HCC, even when considered resistant to the initial form of TACE.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka 565-0871, Japan. n-maeda@radiol.med.osaka-u.ac.jp
authors.forename: Noboru
authors.initials: N
authors.lastname: Maeda
authors.forename: Keigo
authors.initials: K
authors.lastname: Osuga
authors.forename: Hiroki
authors.initials: H
authors.lastname: Higashihara
authors.forename: Kaname
authors.initials: K
authors.lastname: Tomoda
authors.forename: Koji
authors.initials: K
authors.lastname: Mikami
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Hironobu
authors.initials: H
authors.lastname: Nakamura
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Tomiyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage*; D018450:Disease Progression; D004655:Emulsions; D015251:Epirubicin / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D004655:Emulsions; D015251:Epirubicin; D004998:Ethiodized Oil; D002945:Cisplatin