title: Chemoembolization with doxorubicin-eluting beads for unresectable hepatocellular carcinoma: five-year survival analysis.
abstract: OBJECTIVE
  The purpose of this study was to report on the 5-year survival of hepatocellular carcinoma (HCC) patients treated with DC Bead loaded with doxorubicin (DEB-DOX) in a scheduled scheme in up to three treatments and thereafter on demand.
  
  
  METHODS
  173 HCC patients not suitable for curable treatments were prospectively enrolled (mean age 70.4 ± 7.4 years). Child-Pugh (Child) class was A/B (102/71 [59/41 %]), Okuda stage was 0/1/2 (91/61/19 [53.2/35.7/11.1 %]), and mean lesion diameter was 7.6 ± 2.1 cm. Lesion morphology was one dominant ≤5 cm (22 %), one dominant >5 cm (41.6 %), multifocal ≤5 (26 %), and multifocal >5 (10.4 %).
  
  
  RESULTS
  Overall survival at 1, 2, 3, 4, and 5 years was 93.6, 83.8, 62, 41.04, and 22.5 %, with higher rates achieved in Child class A compared with Child class B patients (95, 88.2, 61.7, 45, and 29.4 % vs. 91.5, 75, 50.7, 35.2, and 12.8 %). Mean overall survival was 43.8 months (range 1.2-64.8). Cumulative survival was better for Child class A compared with Child class B patients (p = 0.029). For patients with dominant lesions ≤5 cm 1-, 2-, 3-, 4-, and 5-year survival rates were 100, 95.2, 71.4, 66.6, and 47.6 % for Child class A and 94.1, 88.2, 58.8, 41.2, 29.4, and 23.5 % for Child class B patients. Regarding DEB-DOX treatment, multivariate analysis identified number of lesions (p = 0.033), lesion vascularity (p < 0.0001), initially achieved complete response (p < 0.0001), and objective response (p = 0.046) as significant and independent determinants of 5-year survival.
  
  
  CONCLUSIONS
  DEB-DOX results, with high rates of 5-year survival for patients, not amenable to curative treatments. Number of lesions, lesion vascularity, and local response were significant independent determinants of 5-year survival.
authors.affiliation: Second Department of Radiology, University of Athens, Athens, Greece. kmalag@otonet.gr
authors.forename: Katerina
authors.initials: K
authors.lastname: Malagari
authors.forename: Mary
authors.initials: M
authors.lastname: Pomoni
authors.forename: Hippocrates
authors.initials: H
authors.lastname: Moschouris
authors.forename: Evanthia
authors.initials: E
authors.lastname: Bouma
authors.forename: John
authors.initials: J
authors.lastname: Koskinas
authors.forename: Aspasia
authors.initials: A
authors.lastname: Stefaniotou
authors.forename: Athanasios
authors.initials: A
authors.lastname: Marinis
authors.forename: Alexios
authors.initials: A
authors.lastname: Kelekis
authors.forename: Efthymia
authors.initials: E
authors.lastname: Alexopoulou
authors.forename: Achilles
authors.initials: A
authors.lastname: Chatziioannou
authors.forename: Katerina
authors.initials: K
authors.lastname: Chatzimichael
authors.forename: Spyridon
authors.initials: S
authors.lastname: Dourakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kelekis
authors.forename: Spyros
authors.initials: S
authors.lastname: Rizos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kelekis
mesh_terms: D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media; D004317:Doxorubicin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D009389:Neovascularization, Pathologic / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000903:Antibiotics, Antineoplastic; D003287:Contrast Media; D004317:Doxorubicin