title: Single- versus Triple-Drug Chemoembolization for Hepatocellular Carcinoma: Comparing Outcomes by Toxicity, Imaging Response, and Survival.
abstract: OBJECTIVE
  To determine the efficacy of single- versus triple-drug chemoembolization for the treatment of hepatocellular carcinoma, as measured by toxicity, tumor response, time to progression (TTP), and overall survival (OS).
  
  
  METHODS
  A single-center retrospective review was performed on 337 patients who underwent chemoembolization over a 14-year period; 172 patients underwent triple-drug conventional transarterial chemoembolization, and 165 patients underwent single-agent doxorubicin chemoembolization. Imaging characteristics and clinical follow-up after conventional transarterial chemoembolization were evaluated to determine TTP. Imaging response was determined per World Health Organization and European Association for the Study of Liver criteria. OS from time of first chemoembolization was calculated.
  
  
  RESULTS
  Median TTP was similar between groups: 7.9 months (95% confidence interval [CI], 7.1-9.4) and 6.8 months (95% CI, 4.6-8.6) for triple- and single-drug regimens, respectively (P > .05). For single-agent conventional transarterial chemoembolization, median OS varied significantly by Barcelona Clinic for Liver Cancer (BCLC) stage: A, 40.8 months; B, 36.4 months; C, 10.9 months (P < .01). Median OS for triple-drug therapy also varied significantly by BCLC: A, 28.9 months; B, 18.1 months; C, 9.0 months (P < .01). Single-drug conventional transarterial chemoembolization demonstrated longer median OS compared with triple-drug therapy (P < .05) for BCLC A/B patients.
  
  
  CONCLUSIONS
  Single-agent chemoembolization with doxorubicin and ethiodized oil demonstrates acceptable efficacy as measured by TTP and OS. Results compare favorably with traditional triple-drug therapy.
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Samdeep K
authors.initials: SK
authors.lastname: Mouli
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Ryan
authors.initials: R
authors.lastname: Hickey
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Bartley
authors.initials: B
authors.lastname: Thornburg
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Kush
authors.initials: K
authors.lastname: Desai
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Gabr
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Kallini
authors.affiliation: Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Halla
authors.initials: H
authors.lastname: Niemeri
authors.affiliation: Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Sheetal
authors.initials: S
authors.lastname: Kircher
authors.affiliation: Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.affiliation: Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson Iii
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Ramona
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611; Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611. Electronic address: r-lewandowski@northwestern.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D002641:Chicago; D002945:Cisplatin / Q000008:administration & dosage; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D016685:Mitomycin; D004998:Ethiodized Oil; D004317:Doxorubicin; D002945:Cisplatin