TRANSCATHETER OILY CHEMOEMBOLIZATION IN THE MANAGEMENT OF ADVANCED HEPATOCELLULAR-CARCINOMA IN CIRRHOSIS - RESULTS OF A WESTERN COMPARATIVE-STUDY IN 60 PATIENTS

Transcatheter oily chemoembolization is widely used as palliative therapy for inoperable hepatocellular carcinoma in high-incidence Asiatic areas. To assess its usefulness in the Western form of this cancer, 30 French patients were treated between 1987 and 1990 by intraarterial hepatic injection of a Lipiodoldoxorubicin emulsion followed by embolization with 0.5 to 1 mm gelatin sponge particles. The number of procedures ranged from one to five. All patient had advanced, symptomatic and inoperable hepatocellular carcinoma (Okuda's staging: I, n = 8; II, n = 14; III, n = 8); none was found under systematic screening. All had underlying cirrhosis (Child-Pugh's class: A, n = 15; B, n = 12; C, n = 3) that was alcoholic in origin in 27 cases and posthepatitic B in origin in 3 cases. The results of the treatment were assessed by comparison with a group of 30 untreated patients admitted to the same unit between 1984 and 1987. Patients of both groups were closely matched for clinical presentation, global disease staging and precise anatomical extension. The overall 1- and 2-yr survival rate was 59% and 30%, respectively, for the treated patients vs. 0% at 1 yr for the untreated patients. The latter all died from local disease with end-stage liver failure and/or uncontrollable variceal bleeding. In the former, the three patients with Child's class C cirrhosis died after the first procedure. During the follow-up (range = 3 to 26 mo), 11 additional patients died, 8 from metastatic generalization. In four of these cases, an adjuvant systemic chemotherapy with epirubicin was given and provided an effective response to functional symptoms in two cases (loss of pain caused by bone metastases). Fifteen autopsies were performed in the untreated group and all showed a cancerous thrombus of the main portal trunk, whereas this was found in only 1 of 10 autopsies in the treated group. We conclude that transcatheter oily chemoembolization is an efficient palliative treatment in the Western form of hepatocellular carcinoma complicating cirrhosis; it acts as a locoregional therapy that prevents the cancerous invasion of the portal system. Further trials are needed to define the best therapy to prevent or to treat extrahepatic dissemination.