Vascular and Interventional Radiology

Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma in Patients with Cirrhosis: Evaluation of Damage to Nontumorous Liver Tissue—Long-term Prospective Study

Abstract

PURPOSE: To evaluate damage to cirrhotic liver tissue after transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC).

MATERIALS AND METHODS: TACE was performed in 111 patients with HCC that involved less than 30% of the liver. Baseline liver function was evaluated with Child-Pugh scores and other indicators. Eighty-two patients had Child-Pugh class A disease, 27 had class B disease, and two had class C disease. All patients underwent chemotherapy followed by gelatin sponge particle embolization in the proper (“complete” embolization; n = 69) or right or left main (“partial” embolization; n = 42) hepatic artery. Liver function was assessed 4 months later, and 95 patients underwent a second TACE (complete embolization in 57, partial in 38). Liver function was again assessed 4 months later in 60 patients.

RESULTS: No patient died. Child-Pugh scores increased in all patients from a mean 5.96 to 6.28 (not significant) and 6.51 (P = .05) after first and second TACEs, respectively. In patients with class A disease, scores increased from a mean 5.37 to 5.73 (P = .01) and 5.89 (P = .001) after first and second TACEs, respectively; in patients with class B disease, scores changed from a mean of 7.48 to 7.67 and 7.30 after first and second TACEs, respectively (not significant).

CONCLUSION: TACE does not induce significant long-term worsening of liver function in patients with class A or B cirrhosis.

References

1 Rustgui VK. Epidemiology of hepatocellular carcinoma. Gastroenterol Clin North Am 1987; 16:545-551. Crossref, Google Scholar
2 Muir C, Waterhouse J, Mack T, et al. Cancer incidence in five continents Vol 5. Lyon, France: International Agency for Research on Cancer, 1987; 88. Google Scholar
3 Zamann SN, Johnson PJ, Williams R. Silent cirrhosis in patients with hepatocellular carcinoma. Cancer 1990; 65:1607-1610. Crossref, Medline, Google Scholar
4 Simonetti GR, Liberati A, Angiolini C, Pagliaro L. Treatment of hepatocellular carcinoma: a systematic review of randomized controlled trials. Ann Oncol 1997; 8:117-136. Crossref, Medline, Google Scholar
5 Okuda K. Hepatocellular carcinoma: recent progress. Hepatology 1992; 15:948-955. Crossref, Medline, Google Scholar
6 Dusheiko GM, Hobbs KEF, Dick R, Burroughs AK. Treatment of small hepatocellular carcinomas. Lancet 1992; 340:285-288. Crossref, Medline, Google Scholar
7 Ikeda K, Saitoh S, Koida I, et al. A multivariate analysis of risk factors for hepatocellular carcinogenesis: a prospective observation of 795 patients with viral and alcholic cirrhosis. Hepatology 1993; 18:47-53. Crossref, Medline, Google Scholar
8 Adachi E, Maeda T, Matsumata T, et al. Risk factors for intrahepatic recurrence in human small hepatocellular carcinoma. Gastroenterology 1995; 108:768-775. Crossref, Medline, Google Scholar
9 Hatanaka Y, Yamashita Y, Takahashi M, et al. Unresectable hepatocellular carcinoma: analysis of prognostic factors in transcatheter management. Radiology 1995; 195:747-752. Link, Google Scholar
10 Levin B, Amos C. Therapy of unresectable hepatocellular carcinoma. N Engl J Med 1995; 332:1294-1296. Crossref, Medline, Google Scholar
11 Tsuzuki T, Sugioka A, Ueda M, et al. Hepatic resection for hepatocellular carcinoma. Surgery 1990; 107:511-520. Medline, Google Scholar
12 Iwatsuki S, Starzl TE, Sheahan DG, et al. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg 1991; 214:221-229. Crossref, Medline, Google Scholar
13 Bismuth H, Chiche L, Adam R, Castaing D, Diamond T, Dennison A. Liver transplantation versus resection for hepatocellular carcinoma in cirrhosis. Ann Surg 1993; 218:145-251. Crossref, Medline, Google Scholar
14 Livraghi T, Giorgio A, Marin G, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology 1995; 197:101-108. Link, Google Scholar
15 Rossi S, Buscarini E, Garbagnati F, et al. Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. AJR Am J Roentgenol 1998; 170:1015-1022. Crossref, Medline, Google Scholar
16 Okada S. Transcatheter arterial embolization for advanced hepatocellular carcinoma: the controversy continues (editorial). Hepatology 1998; 27:1743-1744. Crossref, Medline, Google Scholar
17 Cancer Liver Italian Program (CLIP) Group. Tamoxifen in treatment of hepatocellular carcinoma: a randomised controlled trial. Lancet 1998; 352:17-20. Crossref, Medline, Google Scholar
18 Ryder SD, Rizzi PM, Metivier E, Karani J, Williams R. Chemoembolization with lipiodol and doxorubicin: applicability in British patients with hepatocellular carcinoma. Gut 1996; 38:125-128. Crossref, Medline, Google Scholar
19 Chung JW, Park JH, Han JK, et al. Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology 1996; 198:33-40. Link, Google Scholar
20 Bronowicki JP, Vetter D, Dumas F, et al. Transcatheter oily chemoembolization for hepatocellular carcinoma: a 4-year study of 127 French patients. Cancer 1994; 74:16-24. Crossref, Medline, Google Scholar
21 Farinati F, De Maria N, Marafin C, et al. Unresectable hepatocellular carcinoma in cirrhosis. Dig Dis Sci 1996; 14:2332-2339. Google Scholar
22 Liaw YF, Lin DY. Transcatheter hepatic arterial embolization in the treatment of hepatocellular carcinoma. Hepatogastroenterology 1990; 37:484-488. Medline, Google Scholar
23 Miyoshi S, Minami Y, Kawata S, et al. Changes in hepatic functional reserve after transcatheter embolization of hepatocellular carcinoma. J Hepatol 1988; 6:332-336. Crossref, Medline, Google Scholar
24 Khan KN, Nakata K, Kusumoto Y, et al. Evaluation of nontumorous tissue damage by transcatheter arterial embolization for hepatocellular carcinoma. Cancer Res 1991; 51:5667-5671. Medline, Google Scholar
25 Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni ME, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60:646-649. Crossref, Medline, Google Scholar
26 Matsui O, Kadoya M, Kameyama T, et al. Benign and malignant nodules in cirrhotic livers: distinction based on blood supply. Radiology 1991; 178:493-497. Link, Google Scholar
27 Kan Z, Sato M, Ivancev K, et al. Distribution and effect of iodized poppyseed oil in the liver after hepatic artery embolization: experimental study in several animal species. Radiology 1993; 186:861-866. Link, Google Scholar
28 Roul JL, Bourguet P, Bretagne JF, et al. Hepatic artery injection of I-131–labeled lipiodol. I. Biodistribution study results in patients with hepatocellular carcinoma and liver metastases. Radiology 1988; 168:541-545. Google Scholar
29 Bruix J, Castells A, Montanya X, et al. Phase II study of transarterial embolization in European patients with hepatocellular carcinoma: need for controlled trials. Hepatology 1994; 20:643-650. Crossref, Medline, Google Scholar
30 Ikeda K, Kumada H, Saitoh S, Arase Y, Chayama K. Effect of repeated transcatheter arterial embolization on the survival time in patients with hepatocellular carcinoma. Cancer 1991; 68:2150-2154. Crossref, Medline, Google Scholar
31 Bronowicki JP, Boudjema K, Chone L, et al. Comparison of resection, liver transplantation and transcatheter oily chemoembolization in the treatment of hepatocellular carcinoma. J Hepatology 1996; 24:293-300. Crossref, Medline, Google Scholar
32 Lin DY, Liaw YF, Lee TY, Lai CM. Hepatic arterial embolization in patients with unresectable hepatocellular carcinoma: a randomized controlled trial. Gastroenterology 1988; 94:453-456. Crossref, Medline, Google Scholar
33 Yamashita Y, Takahashi M, Koga Y, et al. Prognostic factors in the treatment of hepatocellular carcinoma with transcatheter arterial embolization and arterial infusion. Cancer 1991; 67:385-391. Crossref, Medline, Google Scholar
34 Harada T, Matsuo K, Inoue T, Tamesue S, Inoue T, Nakamura H. Is preoperative hepatic arterial chemoembolization safe and effective for hepatocellular carcinoma?. Ann Surg 1996; 224:4-9. Crossref, Medline, Google Scholar
35 Yu YQ, Xu DB, Zhou XD, Lu JZ, Tang ZY, Mack P. Experience with liver resection after hepatic arterial chemoembolization for hepatocellular carcinoma. Cancer 1993; 71:62-65. Crossref, Medline, Google Scholar
36 Bartolozzi C, Lencioni R, Caramella D, et al. Treatment of large HCC: transcatheter arterial chemoembolization combined with percutaneous ethanol injection versus repeated transcatheter arterial chemoembolization. Radiology 1995; 197:812-818. Link, Google Scholar
37 Pelletier G, Roche A, Olivier I, et al. A randomized trial of hepatic arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Hepatol 1990; 11:181-184. Crossref, Medline, Google Scholar
38 Madden MV, Krige JEJ, Bailey S, et al. Randomized trial of targeted chemotherapy with lipiodol and 5-epidoxorubicin compared with symptomatic treatment for hepatoma. Gut 1993; 34:1598-1600. Crossref, Medline, Google Scholar
39 Groupe D'Etude et de Traitement du Carcinome Hépatocellulaire. A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma. N Eng J Med 1995; 11:1256-1261. Google Scholar
40 Bruix J, Llovet JM, Castells A, et al. Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology 1998; 27:1578-1583. Crossref, Medline, Google Scholar
41 Simonetti RG, Liberati A, Angiolini C, Pagliaro L. Treatment of hepatocellular carcinoma: a systematic review of randomized controlled trials. Ann Oncol 1997; 8:117-136. Crossref, Medline, Google Scholar
42 Kanematsu T, Matsumata T, Shirabe K, et al. A comparative study of hepatic resection and trascatheter arterial embolization for the treatment of primary hepatocellular carcinoma. Cancer 1993; 71:2181-2186. Crossref, Medline, Google Scholar
43 Yamada R, Sato M, Kayabata M, et al. Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology 1983; 148:397-401. Link, Google Scholar
44 Yamashita Y, Torashima M, Oguni T, et al. Liver parenchymal changes after transcatheter arterial embolization therapy for hepatoma: CT evaluation. Abdom Imaging 1993; 18:352-356. Crossref, Medline, Google Scholar

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Published in print: Apr 2000

Vol. 215, No. 1

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