Combined Transcatheter Arterial Chemoembolization and Local Radiotherapy for Unresectable Hepatocellular Carcinoma

Seong, Jinsil; Keum, Ki Chang; Han, Kwang Hyub; Lee, Do Yun; Lee, Jong Tae; Chon, Chae Yoon; Moon, Young Myoung; Kim, Gwi Eon; Suh, Chang Ok

Abstract

PURPOSE: The best prognosis for hepatocellular carcinoma can be achieved with surgical resection. However, the number of resected cases is limited due to the advanced lesion or associated liver disease. A trial of combined transcatheter arterial chemoembolization(TACE) and local radiotherapy(RT) for unresectable hepatocellular carcinoma(HCC) was prospectively conducted and its efficacy and toxicity were investigated.
MATERIALS AND METHODS
From 1992 to 1994, 30 patients with unresectable HCC due either to advanced lesion or to associated cirrhosis were entered in the study.Exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child's class C, tumors occupying more than two- thirds of the whole liver, and an ECOG scale of more than 3. Patient characteristics were:mean tumor size 8.95 +/- 3.4cm, serum AFP + in all patients, portal vein thrombosis in 11 patients, liver cirrhosis in 22 patients, and UICC stage III and IVA in 10 and 20 patients, respectively. TACE was performed with the mixture of Lipiodol(5ml) and Adriamycin(50mg) and Gelfoam embolization. RT(mean dose 44.0 +/-9.3Gy) was followed within 7- 10 days with conventional fractionation.
RESULTS
An objective response was observed in 19 patients(63.3%). Survival rates at 1,2, and 3 years were 67%, 33.3% and 22.2%, respectively. Median survival was 17 months. There were 6 patients surviving more than 3 years. Distant metastasis occurred in 10 patients, with 8 in the lung only and 2in both lung and bone. Toxicity included transient elevation of liver function test in all patients, fever in 20,thrombocytopenia in 4, and nausea and vomiting in 1. There was no treatment-related death.
CONCLUSION
Combined TACE and RT appear to produce a favorable response and survival results with minimal toxicity.