Background: Hepatocellular carcinoma (HCC) is a common malignancy worldwide with limited effective therapeutic options available or appropriate for cirrhotic patients.
Methods: Chemoembolization, using sequential intra-arterial doxorubicin/ethiodized oil and gelatin sponge particle/ethanol embolization, was used to treat patients with unresectable HCC localized to the liver. Fifty-two patients were treated in this manner from 1988 to 1992. The objective response was determined by sequential computed tomography (CT) scans.
Results: Of the 47 patients evaluable for response, 20 (43%) achieved a partial response, and 12 (26%) achieved a minor response. Sixteen patients underwent repeated chemoembolization for locally recurrent disease as many as three times after the initial procedure. All 52 patients were evaluable for survival and toxicity, with a median follow-up of 14 months. Twelve-month survival was 60%, and median survival was 16 months. This compares favorably with values reported in the literature of approximately 20% and 6-14 weeks, respectively. There was a 17% 30-day mortality, with a slightly higher risk for patients with portal vein obstruction. Other toxicities generally were mild and transient, including fever, pain, encephalopathy, and malaise.
Conclusions: Chemoembolization may enhance survival for patients with unresectable, localized HCC. It appears to be an effective alternative to standard treatment, even in cirrhotic patients.