TREATMENT OF INOPERABLE HEPATOCELLULAR-CARCINOMA BY TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION USING AN EMULSION OF CISPLATIN IN IODIZED OIL AND GELFOAM

Eighty patients with inoperable hepatocellular carcinoma (HCC) were treated by transcatheter arterial chemoembolization using an emulsion of Lipiodol and Cisplatin. In 59 patients, gelfoam embolization was also given. The tumour size ranged from 0.5 cm to 33 cm in maximum diameter with the median diameter being 8 cm. The chemoembolization sessions were repeated every 1 1/2 to 3 months. The number of sessions the patients underwent varied from 1 to 11, with the mean number of sessions being 3.7. The HCC either disappeared completely or decreased in size in 44 patients (55%). In patients having an HCC of 12 cm or less in size, 31 out of 41 (75.6%) who had the addition of gelfoam demonstrated decrease in tumour size, while seven out of 11 (63.6%) without the addition of gelfoam demonstrated decrease in tumour size. In patients having an HCC of more than 12 cm in size, only six out of 18 (33.3%) who had the addition of gelfoam demonstrated reduction in tumour size and none of the 10 patients without the addition of gelfoam responded. Thus, HCCs of 12 cm or less in size responded better than larger ones to chemoembolization (P < 0.0001) while the addition of gelfoam enhanced the response (P = 0.039). The 1 year survival rate for the 80 patients was 53% and the 2 years survival rate was 38%. The median survival was 13 months. For patients having an HCC of 12 cm or less in size, the 1 year and 2 year survival rates were 69% and 47% respectively. For patients having a larger tumour, the 1 year survival rate was 24%. For patients in whom there was a decrease in tumour size after chemoembolization, the 1 year and 2 year survival rates were 79% and 60% respectively. For patients in whom there was no response, the 1 year survival rate was 21%. Thus, patients with tumours of 12 cm or less in size survived significantly longer than those having larger tumours (P < 0.0001) while responders survived significantly longer than non-responders (P < 0.0001).