title: The Safety and Clinical Outcomes of Chemoembolization in Child-Pugh Class C Patients with Hepatocellular Carcinomas.
abstract: OBJECTIVE
  To evaluate the safety and clinical outcomes of chemoembolization in Child-Pugh class C patients with hepatocellular carcinomas (HCC).
  
  
  METHODS
  The study comprised 55 patients with HCC who were classified as Child-Pugh class C and who underwent initial chemoembolization between January 2003 and December 2012. Selective chemoembolization was performed in all technically feasible cases to minimize procedure-related complications. All adverse events within 30 days were recorded using the Common Terminology Criteria for Adverse Events (CTCAE). The tumor response to chemoembolization was evaluated using the modified Response Evaluation Criteria In Solid Tumors.
  
  
  RESULTS
  Thirty (54.5%) patients were within the Milan criteria, and 25 (45.5%) were beyond. The mortality of study subjects at 30 days was 5.5%. Major complications were observed in five (9.1%) patients who were all beyond the Milan criteria: two hepatic failures, one hepatic encephalopathy, and two CTCAE grade 3 increases in aspartate aminotransferase/alanine aminotransferase abnormality. The mean length of hospitalization was 6.3 ± 8.3 days (standard deviation), and 18 (32.7%) patients were discharged on the next day after chemoembolization. The tumor responses of the patients who met the Milan criteria were significantly higher (p = 0.014) than those of the patients who did not. The overall median survival was 7.1 months (95% confidence interval: 4.4-9.8 months).
  
  
  CONCLUSIONS
  Even in patients with Child-Pugh class C, chemoembolization can be performed safely with a selective technique in selected cases with a small tumor burden.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors.forename: Tae Won
authors.initials: TW
authors.lastname: Choi
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors.forename: Hyo-Cheol
authors.initials: HC
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors.forename: Jeong-Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors.forename: Su Jong
authors.initials: SJ
authors.lastname: Yu
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors.forename: Beomsik
authors.initials: B
authors.lastname: Kang
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors.forename: Saebeom
authors.initials: S
authors.lastname: Hur
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors.forename: Myungsu
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors.forename: Hwan Jun
authors.initials: HJ
authors.lastname: Jae
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Chemoembolization; Hepatocellular carcinoma; Liver cirrhosis; Liver failure; Safety