To evaluate the efficacy of TACE (transcatheter arterial chemoembolization) with use of low-dose versus conventional-dose anticancer drugs in hepatocellular carcinoma patients with cirrhosis and to analyze their prognostic factors.
Eight-two patients with unresectable hepatocellular carcinoma underwent super-selective TACE. Patients in group A (n = 40) received low-dose anticancer drugs. Patients in group B (n = 42) were given conventional-dose of anticancer drugs. Tumor response and survival time in the two groups were compared. Cox proportion-hazards modeling was used to evaluate the relative importance of prognostic variables.
There was no significant difference between the two groups in initial tumor response (P < 0.05). The median survival in all patients was 18 months (mo). The median survival in groups A and B were 20 mo and 16 mo respectively. The cumulative survival rates at 6, 12, 18, 24, 30 mo were 68.4%, 57.6%, 38.4%, 26.6%, 19.9% in group A, and 62.6%, 43.8%, 31.9%, 26.5%, 26.5% in group B. There was no significant difference in survival between the two groups (P > 0.05). The factors influencing prognosis were Child-Pugh scores (P < 0.0001), tumor thrombus in the portal vein (P < 0.0001), tumor size (P < 0.0001), method of embolization (P < 0.0001), TACE times (P < 0.001). The dosage of anticancer drugs employed in TACE was not relevant to the survival rates (P = 0.883).
TACE with use of large-dose anticancer drugs does not significantly enhance the anticancer effects and survival compared that with lowdose anticancer drugs. The therapeutic effect of TACE was mainly attributed to embolization of the artery rather than to anticancer drugs.
[Show abstract][Hide abstract] ABSTRACT: With the introduction of spiral computed tomography and the development of novel imaging technology in recent years, multidetector-row computed tomography (MDCT) has increasingly been used for the diagnosis of various lesions, especially hepatocellular carcinoma (HCC), due to its volume acquisitions, short scanning time, and especially its double-phase scanning nature, which takes advantage of the dual blood supply of liver. Multidetector-row computed tomography is used to classify HCC into several types based on the blood supply and the histological characteristics of HCC. The evaluation of HCC by MDCT provides crucial clues for the doctors to adopt correct clinical management strategies such as the selection of the appropriate dose of lipiodol before transcatheter arterial chemoembolization (TACE) and the prediction of the prognosis of HCC after TACE. The MDCT scanning allows doctors to choose the region of interest and to evaluate the blood supply according to the lipiodol uptake in order to decide whether there is recrudescence and whether a repeated therapy should be taken. This review describes MDCT, its biphasic scanning, its evaluation of blood supply in HCC and the subsequent classification of HCC, its therapeutic significance before TACE and the prognostic value after TACE.
Journal of Gastroenterology and Hepatology 07/2006; 21(6):941-6. DOI:10.1111/j.1440-1746.2006.04474.x · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chemoembolization (TACE) improves survival in cirrhotic patients with hepatocellular carcinoma (HCC). The optimal schedule, or whether embolization (TAE) alone gives the same survival advantage, is not known.
To evaluate whether specific patient characteristics and/or radiological transarterial techniques result in better outcomes.
A PubMed search was carried out for cohort and randomized trials (n = 175) testing transarterial therapies; meta-analysis was performed where appropriate.
Anticancer drugs were used as sole agent in 75% of cases (double 15% and triple 6%): doxorubicin (36%), cisplatin (31%), epirubicin (12%), mitoxantrone (8%), mitomycin (8%), and SMANCS (5%). Embolizing agents used were: gelatin sponge particles (71%), polyvinyl alcohol (PVA) particles (8%), degradable starch microspheres (DSM) (4%), and embospheres (4%). Sessions per patient were 2.5 +/- 1.5 (interval: 2 months). Objective response was 40 +/- 20%; survival rates at 1, 2, 3, and 5 years were: 62 +/- 20%, 42 +/- 17%, 30 +/- 15%, and 19 +/- 16%, respectively, and survival time was 18 +/- 9.5 months. The post-TACE complications were: acute liver failure, 7.5% (range 0-49%); acute renal failure, 1.8% (0-13%); encephalopathy, 1.8% (0-16%); ascites, 8.3% (0-52%); upper gastrointestinal bleeding; 3% (0-22%); and hepatic or splenic abscess, 1.3% (0-2.5%). Treatment-related mortality was 2.4% (0-9.5%), mainly due to acute liver failure. Our meta-analysis of nine randomized controlled trials (RCTs) confirmed that TACE improves survival; but a meta-analysis of TACE versus TAE alone (3 RCTs, 412 patients) demonstrated no survival difference.
No chemotherapeutic agent appears better than any other. There is no evidence for benefit with lipiodol. Gelatin sponge is the most used embolic agent, but PVA particles may be better. TAE appears as effective as TACE. New strategies to reduce the risk of post-TACE complications are required.
[Show abstract][Hide abstract] ABSTRACT: To study liver function damage after transcatheter arterial chemoembolization (TACE) with use of low-dose versus conventional-dose anticancer drugs in patients with hepatocellular carcinoma (HCC).
One hundred and twelve patients with unresectable HCC were randomly divided into two groups to receive superselective TACE. Patients in group A (n=52) received low-dose anticancer drugs: mitomycin C (MMC) 2-8 mg, epirubicin (EPI) 5-10 mg and carboplatin (CBP) 100mg were used. Patients in group B (n=60) were given conventional-dose of anticancer drugs (MMC 10 mg, EPI 40 mg, CBP 300 mg). Lipiodol-anticancer drugs emulsion was injected into the feeding arteries of tumors followed by gelatin sponge (GS) or polyvinyl alcohol (PVA) particles embolization. Liver function was evaluated with Child-Pugh scores, total bilirubin (TBIL), albumin (ALB) and alanine aminotransferase (ALT) before TACE, three days, one week (wk) and four wk after procedures.
In both groups, TBIL, ALT, and Child-Pugh scores increased (P < 0.001 or P < 0.05) and ALB decreased (P < 0.001 or P < 0.01) three days and one wk after TACE. The different between the parameters obtained four wk after the procedure and baseline parameters was not significant in group A (P > 0.05). In group B, however, significant difference (P < 0.05) was found in all parameters except ALT.
Superselective TACE with use of low-dose anticancer drugs induces transient impairment in liver function, but use of conventional-dose anticancer drugs can cause lasting, more serious worsening of liver function.
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