title: Transarterial chemoembolisation: effect of selectivity on tolerance, tumour response and survival.
abstract: OBJECTIVE
  To compare selective and non-selective TACE techniques in the treatment of HCC with a special emphasis on clinical and liver tolerance, tumour response and survival.
  
  
  METHODS
  184 patients with advanced HCC were retrospectively included. Three different TACE techniques were compared: non selective lipiodol-chemotherapy + non selective embolisation (TACE-technique group 1), non selective lipiodol-chemotherapy + selective embolisation (group 2), and selective lipiodol-chemotherapy + selective embolisation (group 3).
  
  
  RESULTS
  In multivariate analysis TACE-technique group is an independently significant prognostic factor for poor clinical tolerance, poor liver tolerance and tumour response. The rate of patients with poor clinical tolerance was lower in group 3 (27.0%) than in groups 1 (64.1%, p < 10(-3)) or 2 (66.7%, p < 10(-3)). The rate of patients with poor liver tolerance was higher in group 2 (34.0%) than in groups 1 (17.6%, p = 0.050) or 3 (6.9%, p = 0.011). The rate of patients with tumour response was higher when embolisation was selective versus non-selective, i.e., group 2 + 3 (78.7%) versus group 1 (62.5%, p = 0.054). Overall survival was not significantly different between the three groups (p = 0.383).
  
  
  CONCLUSIONS
  Both selective techniques resulted in better tumour response. As for improving tolerance, our study suggests that the main technical factor is the use of selective lipiodol-chemotherapy injection.
authors.affiliation: Department of Radiology, CHU Angers, Angers, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Bouvier
authors.forename: Violaine
authors.initials: V
authors.lastname: Ozenne
authors.forename: Christophe
authors.initials: C
authors.lastname: Aubé
authors.forename: Jérôme
authors.initials: J
authors.lastname: Boursier
authors.forename: Marie Pierre
authors.initials: MP
authors.lastname: Vullierme
authors.forename: Francine
authors.initials: F
authors.lastname: Thouveny
authors.forename: Olivier
authors.initials: O
authors.lastname: Farges
authors.forename: Valérie
authors.initials: V
authors.lastname: Vilgrain
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D004998:Ethiodized Oil; C044834:iodixanol