WASHINGTON, DC - Given the wide variation in its reported mortality rates, the perceived potential of transcatheter arterial chemoembolization (TACE) for inoperable hepatocellular carcinoma has fallen considerably. But a German researcher has spoken in favor of the controversial therapy at the American Roentgen Ray Society meeting on May 9.
Dr. Andreas Lubienski presented the findings from his group's study, conducted at the University Hospital in Heidelberg. He described hepatocellular carcinoma as the most common worldwide lethal malignancy, occurring in 80% of patients with liver cirrhosis. Treatment options include liver transplantation, intravenous chemotherapy, and percutaneous ablation therapies, he said.
In this retrospective study, Lubienski and his group reviewed the records of 41 patients who had undergone transcatheter arterial chemoembolization (TACE) as a palliative treatment for hepatocellular carcinoma. Out of the 41 patients, 26 had been rejected for surgery, seven suffered a recurrence after surgery, and nine underwent TACE as a bridge to a liver transplant. The size of the primary tumors varied from 2.5 cm to 20 cm in diameter.
Embolization suspension was achieved with Lipiodol iodized oil in combination with cisplatin, carbonplatin, or riboblastin. The catheter was positioned in either hepatic artery.
Spiral CT was performed 48 hours after TACE to assess Lipiodol retention. Follow-up was done 12 months later with contrast-enhanced CT, and the long-term outcome was based on the clinical presentation and the imaging results, Lubienski said. A total of 75 embolizations were performed.
In 32% of those cases, superselective embolization was done and TACE was repeated up to five times in each patient if necessary. The median survival rate was 8.9 months, Lubienski reported. The survival rate at one year was 17%. There were no procedure-related deaths and two instances of severe side effects.
"TACE remains the treatment of choice in patients with multi-tumor nodules and partial tumor infiltration." Lubienski said.
Other studies also have advocated TACE as a worthwhile treatment program. A study by researchers from Goethe University in Frankfurt evaluated 123 TACE procedures in 37 patients and found a one-year survival rate of 62%. Those patients with a high Lipiodol retention rate fared the best at 902 days, the group reported. (Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr, Jan. 2000, Vol. 172:1, pp.43-50). An expanded version of the same study, with 85 patients, showed a one-year survival rate of 57% (Radiology, Feb.2000, Vol. 174:2, pp.349-357).
However, a group from Queen Mary Hospital in Hong Kong found that the significant morbidity and mortality associated with TACE made it a questionable treatment method. In this study, data for 484 patients with either inoperable HCC or recurrent HCC after treatment with TACE were reviewed.
TACE was associated with an overall morbidity rate of 23% and a mortality rate of 4.3%. The mortality rate jumped to 20% for patients with tumors greater than 10 cm and poor liver function. The overall one-year survival rate was 49%, the group reported. They concluded that the benefit of TACE was limited, particularly in patients with large tumors and weak livers (J Surg Oncol, Feb. 2000, Vol. 73:2, pp.109-14).
Another article published earlier this year compared chemoembolization techniques to other nonsurgical ablation therapies (RadioGraphics, January 2000, Vol. 20:1, pp. 9-27). The review noted that while chemoembolization was sometimes useful in treating patients with multiple or radiologically occult tumors, it was less effective than localized high-energy devices in killing individual tumors.
Finally, Japanese radiologists from Kurume University compared TACE to cryoreductive therapy and found the embolization therapy lacking. Out of a total of 28 patients, those who underwent TACE had a one-year survival rate of 17%, while those who had cryoreductive therapy had a 48% survival rate (Int J Oncol, Dec.1999, Vol. 15:6, pp.1117-1123).
Lubienski concluded that, based on his study, performing a single treatment of TACE did not increase the chances of survival. Multiple treatments are more likely to be effective, he said. The next stage of research will be to evaluate how effective TACE is when combined with other therapies such as direct tumor ablation, he added.
By Shalmali Pal
AuntMinnie.com staff writer
May 10, 2000
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