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PTU-062 Transarterial chemoembolisation in inoperable hepatocellular carcinoma: a tertiary centre experience
  1. M McMahon1,
  2. R K Popuri2,
  3. N Chalmers2,
  4. M I Prince1
  1. 1Department of Gastroenterology, Manchester Royal Infirmary, Manchester, UK
  2. 2Department of Radiology, Manchester Royal Infirmary, Manchester, UK

Abstract

Introduction Hepatocellular carcinoma (HCC) remains a leading cause of death among cirrhotic patients in the UK.1 Transarterial chemoembolisation has been shown previously to produce modest survival advantages in some patients with inoperable disease.1 ,2 Our aim was to assess the impact of chemoembolisation on survival, and on tumour response, of patients treated in our unit.

Methods All patients undergoing transartertial chemoembolisation from 2002 to 2009 were identified from radiological records. A retrospective case note analysis was carried out, and CT scans were reviewed.

Results Thirty-one patients were identified of whom 21 were male. Mean age at presentation was 63 years (range 31–84 years). One patient was identified as being non-cirrhotic. Of the remainder, 17 patients were known to be cirrhotic and five patients presented during routine surveillance of cirrhosis. The most common aetiology was Hepatitis C. The majority of patients had Childs-Pugh A cirrhosis (80%). The median serum α feto protein (AFP) at presentation was 87 (inter-quartile range 7–3004). 61% had serum AFP >200. Six patients had evidence of extra-hepatic spread at diagnosis. The mean number of treatments was 1.95 (SD 1.23).

Assessment of tumour response was obtained for 23 patients. Nine patients (39%) achieved partial3 tumour response on initial follow-up CT scan. The range of time to follow-up scan was between 6 and 20 weeks (mean 10). Four patients (17%) had stable disease and 10 patients (43%) had evidence of progressive disease. There were two treatment related deaths, one from hepatic necrosis with acute renal failure, one from hepatic necrosis with hepatic decompensation. Mean follow-up was 13.7 months (SD 12.6). Median survival was 359 days (95% CI 254 to 464). Survival at 1 year was 59% (16/27 patients), and 29% (6/21 patients) at 2 years.

Conclusion Objective tumour response rates and survival rates were inferior to those achieved by other centres.1 However, in our patient cohort, stage of disease was more advanced. The use of independent predictors of survival may allow more selective treatment allocation.

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