V. Khanna

Comparison of conventional transarterial chemoembolization (TACE) and chemoembolization with doxorubicin drug eluting beads (DEB) for unresectable hepatocelluar carcinoma (HCC)

Chemoembolization with doxorubicin drug eluting beads (DEB) is a novel locoregional treatment modality for unresectable hepatocellular carcinoma (HCC). Initial animal studies and clinical trials suggest that treatment with DEB may provide safer and more effective short‐term outcomes than conventional chemoembolization. Current study explores long‐term survival benefits.

Prognostic factors for survival in patients with unresectable hepatocellular carcinoma undergoing chemoembolization with doxorubicin drug-eluting beads: a preliminary study

BACKGROUND Transarterial chemoembolization (TACE) with drug-eluting beads (DEB) is a new treatment modality. Little is known about prognostic factors affecting survival after DEB TACE for patients with hepatocellular carcinoma (HCC). METHODS Patients who underwent TACE with doxorubicin DEB for unresectable HCC during 2006-2008 were studied. Survival was calculated from the day of first transcatheter therapy. Survival analysis was performed using Kaplan-Meier estimations. Survival curves were compared using the log-rank test. RESULTS Fifty patients underwent chemoembolization with doxorubicin DEB. They included 39 women and 11 men, with a median age of 57.5 years (range 28-91 years). Eighteen patients died during the study period and 32 remained alive. Overall survival rates at 6 months, 1 year and 2 years from the first administration of doxorubicin DEB TACE were 71%, 65% and 51%, respectively. Prognostic factors found to be significant on univariate analysis were Child-Pugh class, Okuda staging, bilirubin > 2 mg/dl, albumin < 3.0 g/dl, Model for End-stage Liver Disease (MELD) score, serum alphafetoprotein (AFP), Cancer of the Liver Italian Programme (CLIP) score, tumour satisfying Milan criteria, Eastern Cooperative Oncology Group (ECOG) performance status (PS) and Barcelona Clinic Liver Cancer (BCLC) staging. CONCLUSIONS Child-Pugh class, Okuda staging, bilirubin > 2 mg/dl, albumin < 3 g/dl, MELD score, serum AFP, CLIP score, Milan criteria, ECOG PS and BCLC staging were found to be prognostic markers of survival after treatment with doxorubicin DEB TACE in patients with unresectable HCC.

The Effectiveness of Locoregional Therapies versus Supportive Care in Maintaining Survival within the Milan Criteria in Patients with Hepatocellular Carcinoma

PURPOSE To compare survival after treatment with either locoregional therapy (LRT) or supportive care in patients with hepatocellular carcinoma (HCC) within the Milan criteria. MATERIALS AND METHODS Patients with HCC who were classified within the Milan criteria (solitary HCC <or= 5 cm or <or= 3 tumors with none greater than 3 cm in largest diameter, and no macrovascular invasion) and underwent transcatheter therapy or radiofrequency ablation (RF ablation) between 1998 and 2008 were retrospectively studied. Patients with tumor burden within the Milan criteria who received the best supportive care only were used as the control group. Survival within the Milan criteria was compared between those who underwent LRT and patients who underwent supportive care. RESULTS Of 162 patients studied, 110 patients (67.9%) underwent LRT, and 52 patients (32.1%) received supportive care alone. Median survival within the Milan criteria for patients who did and did not receive LRT were 644 days (95% confidence interval [CI], 193-1094) and 162 days (95% CI, 73-250) respectively (P < .001). In patients who received LRT, Child Pugh class was prognostic for survival within the Milan criteria on multivariate analysis (P = .002, hazard ratio 5.16 [2.69-9.89]). The long-term survival for patients who did not undergo transplant was 502 days (95% CI, 91-912) in patients who received LRT and 151 days (95% CI, 59-242) in patients who were treated with supportive care (P < .001). CONCLUSIONS LRT is more effective than supportive care in prolonging survival within the Milan criteria in patients with HCC. The long-term survival in patients not undergoing transplant was significantly longer for patients who received LRT than for patients who were treated with supportive care.