Selective and sequential transarterial chemoembolization: Survival in patients with hepatocellular carcinoma

Purpose: To assess the survival time of patients with HCC following transarterial chemoembolization performed in a highly selective and sequential way. Patients and methods: 124 HCC patients (102 male, 22 female; mean age 63 +/- 11 years) treated with selective and sequential chemoembolization at a single center were included. Selective chemoembolization was performed through a coaxially introduced microcatheter in a segmental or subsegmental hepatic artery. Treatment was stopped after complete stasis of the blood flow in the tumor-feeding vessel. The primary endpoint of the study was overall survival. Results: The median overall survival of the entire patient population was 27.2 months (mo) (+/- 8.9 mo, 95% CI 9.8 mo, 44.6 mo). When stratified according to liver function the median survival was 46.1 mo (+/- 9.0 mo; 95% CI 28.5 mo, 63.7 mo) for Child-Pugh A and 11.1mo (+/- 4.3 mo; 95% CI 2.7 mo, 19.5 mo) for Child-Pugh B (p < .001). The median survival was 46.1 mo (+16.6 mo; 95% CI 13.5 mo, 78.7 mo) for BCLC stage A, 19.7 mo(+/- 2.6 mo; 95% CI 14.6 mo, 24.8 mo) for BCLC stage B, and 14.4 mo(+/- 5.0 mo; 95% CI 4.5 mo, 24.3 mo) for BCLC stage C (p < .01). Conclusion: Selective and sequential chemoembolization offers long survival times in patients with HCC. Those patients with preserved liver function benefit more than patients with limited liver reserve. (C) 2011 Elsevier Ireland Ltd. All rights reserved.