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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2011; 21(02): 113-120
DOI: 10.4103/0971-3026.82294
Interventional Radiology

Trans-arterial chemoembolization (TACE) in patients with unresectable Hepatocellular carcinoma: Experience from a tertiary care centre in India

Shashi Bala Paul
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Shivanand Gamanagatti
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Vishnubhatla Sreenivas
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
,
Sheragaru Hanumanthappa Chandrashekhara
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Amar Mukund
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Manpreet Singh Gulati
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Arun Kumar Gupta
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Subrat Kumar Acharya
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Aims: To evaluate the outcome following transarterial chemoembolization (TACE) and to identify the predictors of survival in patients with unresectable hepatocellular carcinoma (HCC). Material and Methods: HCC patients reporting to our hospital (2001-2007) were subjected to clinical, biochemical, and radiological examination. TACE was performed in those who fulfilled the inclusion criteria. Follow-up assessment was done with multiphase CT scan of the liver at 1, 3, and 6 months. Tumor response and survival rate were estimated. Univariate and multivariate analyses were done for determinants of survival. Results: A total of 73 patients (69 males, 4 females; mean age 49±13.4 years) were subjected to 123 sessions of TACE. The Child′s classification was: A - 56 patients and B - 17 patients. Barcelona Clinic staging was: A - 20 patients, B - 38 patients, and C - 15 patients. Tumor size was ≤5cm in 28 (38%) patients, >5-10 cm in 28 (38%) patients, and >10 cm in 17 (23%) patients. Median follow-up was for 12 months (range: 1-77 months). No significant postprocedure complications were encountered. Overall survival rate was 66%, 47%, and 36.4% at 1, 2, and 3 years, respectively. Tumor size emerged as an important predictor of survival. Conclusion: TACE offers a reasonable palliative therapy for HCC. Initial tumor size is an independent predictor of survival.

Keywords

Hepatocellular carcinoma - survival rate - transarterial chemoembolisation


Publication History

Article published online:
30 July 2021

© 2011. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden. Globocan 2000. Int J Cancer 2001;94:153-6.
  • 2 Tanaka H, Hiyama T, Tsukuma H, Okubo Y, Yamano H, Kitada A, et al. Prevalence of second generation antibody to hepatits C antibody among voluntary blood donors in Osaka, Japan. Cancer Causes Control 1994;5:409-13.
  • 3 Kumar A, Srivastava DN, Chau TT, Long HD, Bal C, Chandra P, et al. Inoperable hepatocellular carcinoma: Transarterial 188Re HDD-labeled iodized oil for treatment--prospective multicenter clinical trial. Radiology 2007;243:509-19.
  • 4 Yumoto Y, Jinno K, Tokuyama K, Araki Y, Ishimitsu T, Maeda H, et al. Hepatocellular carcinoma detected by iodized oil. Radiology 1985;154:19-24.
  • 5 Konno T, Maeda H, Iwai K, Tashiro S, Maki S, Morinaga T, et al. Effect of arterial administration of high-moleculan- weight anticancer agent SMANCS with lipid lymphographic agent on hepatoma. Eur J Cancer Clin Oncol 1983;19:1053-65.
  • 6 Ohishi H, Uchida H, Yoshimura H, Ohue S, Ueda J, Katsuragi M, et al. Hepatocellular carcinoma detected by iodized oil: Use of anticancer agents. Radiology 1985;154:25-9.
  • 7 Takayasu K, Shima Y, Muramatsu Y, Moriyama N, Yamada T, Makuuchi M, et al. Hepatocellular carcinoma: Treatment with intraarterial iodized oil with and without chemotherapeutic agents. Radiology 1987;163:345-51.
  • 8 Llovet JM, Real MI, Montana X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: A randomised controlled trial. Lancet 2002;359:1734-9.
  • 9 Caturelli E, Siena DA, Fusilli S, Villani MR, Schiavone G, Nardella M, et al. Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with cirrhosis: Evaluation of damage to nontumorous liver tissue-long-term prospective study. Radiology 2000;215:123-8.
  • 10 Takayasu K, Arii S, Ikai I, Omata M, Okita K, Ichida T, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 2006;131:461-9.
  • 11 Ji SK, Cho YK, Ahn YS, Kim MY, Park YO, Kim JK, et al. Multivariate analysis of the predictors of survival for patients with hepatocellular carcinoma undergoing transarterial chemoembolization: Focusing on superselective chemoembolization. Korean J Radiol 2008;9:534-40.
  • 12 Savastano S, Miotto D, Casarrubea G, Teso S, Chiesura-Corona M, Feltrin GP. Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with Child′s grade A or B cirrhosis: A multivariate analysis of prognostic factors. J Clin Gastroenterol 1999;28:334-40.
  • 13 Miyayama S, Yamashiro M, Okuda M, Yoshie Y, Sugimori N, Igarashi S, et al. Chemoembolisation for the treatment of large Hepatocellular carcinoma. J Vasc Interv Radiol 2010;21:1226-34.
  • 14 Pisani P, Parkin DM, Ferlay J. Estimates of the world wide mortality from eighteen major cancers in 1985. Implications for prevention and projections of future burden. Int J Cancer 1993;55:891-3.
  • 15 Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108.
  • 16 Paul SB, Chalamalasetty SB, Vishnubhatla S, Madan K, Gamanagatti SR, Batra Y, et al. Clinical Profile, Etiology and Therapeutic Outcome in 324 Hepatocellular Carcinoma Patients at a Tertiary Care Center in India. Oncology 2009;77:162-71.
  • 17 Acharya SK, Madan K, Dattagupta S, Panda SK. Viral hepatitis in India. Natl Med J India 2006;19:203-17.
  • 18 Kumar R, Saraswat MK, Sharma BC, Sakhuja P, Sarin SK. Characteristics of hepatocellular carcinoma in India: A retrospective analysis of 191 cases. Q J Med 2008;101:479-85.
  • 19 Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of esophagus for bleeding esophageal varices. Br J Surg 1973;60:646-8.
  • 20 Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. EASL Panel of Experts on HCC. EASL panel of experts on HCC: Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona EASL conference. European Association for the study of liver. J Hepatol 2001;35:421-30
  • 21 Cillo U, Vitale A, Grigoletto F, Farinati F, Brolese A, Zanus G, et al. Prospective validation of the Barcelona Clinic Liver Cancer staging system. J Hepatol 2006;44:723-31.
  • 22 Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 2003;362:1907-17.
  • 23 Sarin SK, Thakur V, Guptan RC, Saigal S, Malhotra V, Thyagarajan SP, et al. Profile of hepatocellular carcinoma in India: An insight into the possible etiologic associations. J Gastroenterol Hepatol 2001;16:666-73.
  • 24 Murugavel KG, Mohan KV, Pramod NP, Rajasambandam P, Mathews S, Jyanthi V, et al. Correlation of hepatitis B and C viral markers with aflatoxin and AFP in Hepatocellular carcinoma cases from Tamil Nadu. Abstract. Indian J Gastroenterol 1999;18:S37.
  • 25 Kapoor S, Gupta SK, Sehgal RK, Dhiman RK, Chawla Y, Jyotsana. Hepatocellular carcinoma at PGI Chandigarh. Indian J Gastroenterol 1999;18:S36-24.
  • 26 A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma. Groupe d′Etude et de Traitement du Carcinome Hépatocellulaire. N Engl J Med 1995;332:1256-61.
  • 27 Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002;35:1164-71.
  • 28 Vetter D, Wenger JJ, Bergier JM, Doffoel M, Bockel R. Transcatheter oily chemoembolization in the management of advanced hepatocellular carcinoma in cirrhosis: Results of a Western comparative study in 60 patients. Hepatology 1991;13:427-33.
  • 29 Ernst O, Sergent G, Mizurahi D, Delemazure O, Paris J-C, L′Hermine C. Treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization: Comparison of planned periodic chemoembolization and chemoembolization based on tumor response. Am J Roentgenol 1999;172:59-64.
  • 30 Jansen MC, van Hillegersberg R, Chamuleau RA, van Delden OM, Gouma DJ, van Gulik TM. Outcome of regional and local ablative therapies for hepatocellular carcinoma: A collective review. Eur J Surg Oncol 2005;31:331-47.
  • 31 Pelletier G, Ducreux M, Gay F, Luboinski M, Hagège H, Dao T, et al. Treatment of unresectable hepatocellular carcinoma with lipiodol chemoembolization: A multicenter randomized trial. Groupe CHC. J Hepatol 1998;29:129-34.
  • 32 Pelletier G, Roche A, Ink O, Anciaux ML, Derhy S, Rougier P, et al. A randomized trial of hepatic arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Hepatol 1990;11:181-4.