Transarterial chemoembolization for the treatment of hepatocellular carcinoma: a single center experience including 221 patients.
BACKGROUND
Hepatocelluar carcinoma (HCC) is a major health problem in Egypt as well as in many countries. Transarterial chemoemoblization (TACE) is a treatment modality applicable to locally advanced HCC beyond surgery or ablative therapies and is associated with survival improvements. The aim of this study was to assess the outcomes of TACE in our center over the past four years.


METHODS
This is a retrospective cohort study that included 221 patients with locally advanced HCC treated with TACE in a single center between the years 2007 and 2010. The median age was 57 years with male predominance. Liver cirrhosis, viral hepatitis and Bilharziasis were encountered in 64%, 31% and 8% of patients, respectively. Abdominal pain was the most common presenting symptom (67%). Most cases were diagnosed based on radiology (57%) with a TNM stage I or II (73%) and a median AFP value of 150 ng/mL.


RESULTS
221 patients received 440 cycles of TACE with a median of 2 cycles per patient. Cisplatin and doxorubicin (50mg per cycle, each) were the most commonly used drugs. Impaired liver function was the most common toxicity. Liver cell failure occurred in 17% of patients. An objective tumor response was achieved in 44% of cases. The median overall survival (OS) was 16 months (95% CI, 13-19 months) and the median progression free survival (PFS) was 6 months (95% CI, 4.3-7.8 months). Responding patients, Child-Pugh class A and patients receiving standard doses of chemotherapy had a significantly better OS than their counterparts. Only Child-Pugh class A was associated with significantly longer PFS (p < 0.001).


CONCLUSIONS
TACE produces reasonable responses and fair survival rates in locally advanced HCC but with noticeable toxicities. Proper patients' selection and prompt liver support are mandates for improving TACE outcomes.
Department of Medical Oncology/Hematology, National Cancer Institute, Cairo University, Cairo, Egypt.
Ahmed Abdelmabood
AA
Zeeneldin
Salem Eid
SE
Salem
Reda Hassan
RH
Tabashy
Asmaa Ahmed
AA
Ibrahim
Nelly Hassan
NH
Alieldin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods* / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D008113:Liver Neoplasms / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis
Egypt; Hepatocellular carcinoma; National Cancer Institute; Transarterial chemoemoblization; Treatment