Efficacy of chemoembolization for hepatocellular carcinomas: Experience from the gustave roussy institute and the bicetre hospital

Abstract

Chemoembolization (CE) has been used for more than 10 years to treat hepatocellular carcinoma (HCC) in our departments, and three studies have been done. The first was a retrospective study on 232 patients in which CE was performed with doxorubicin and Gelfoam with or without Lipiodol; the response rate was 41% (34.7-47.3%) and survival was better for Okuda stage I disease than for stages I1 and 111 (2-year survival 82, 29, and 0% respectively); for patients with Lipiodol retention the response rate was over 50%. The second study compared CE with doxorubicin and Gelfoam to symptomatic treatment in a randomized manner; it included 42 patients and failed to demonstrate a survival advantage ( 1 -year survival: CE 24% vs. control 31%; NS). The third study is ongoing and tests CE with cis-platinum, Lipiodol, and Gelfoam.According to our experience prospective randomized studies are warranted to define clearly the best indications for CE in HCC.

Transarterial chemoembolization (TACE) using mitomycin and lipiodol with or without degradable starch microspheres for hepatocellular carcinoma: comparative study

“…Notably in our and priorly published studies, radiological response to the therapy was not associated with improved survival. Superior response suggests, that TACE using DSM and lipiodol could be a suitable palliative treatment in patients with HCC [ 18 , 24 , 27 ].…”

Preoperative Systemic Chemoimmunotherapy and Sequential Resection for Unresectable Hepatocellular Carcinoma

“…[1][2][3] Thus, most HCC patients have unresectable disease that is generally considered to be incurable, and the prognosis of these patients is dismal. Intraarterial chemotherapy with lipiodol 4 and transarterial chemoembolization (TACE) 5,6 are widely practiced in the treatment of localized unresectable HCC, but these modalities have not been found to prolong survival in randomized studies. [7][8][9][10] This may be because TACE is not as effective for large and diffuse types of HCC.…”

Hepatocellular Carcinoma: Update on Diagnosis and Treatment

“…The inci dence of complications is low, although a postembolization syndrome (pain, fever, and vomiting) is very common, is treated symp tomatically, and clears quickly. The reduction in blood flow in the adjacent liver may worsen liver function, and the procedure is contrain dicated in patients with Childs class C cirrho sis or portal vein thrombosis [50], Although significant responses to TACE may alTord some palliation, no survival bene fit has been demonstrated [51], In one study, the overall actuarial survival rates were 62% at 12 months, 31 % at 24 months, and 24% at 30 months [52], In another study 1-, 2-, 3-, and 4-year survival rates were 56.1,28.9, 17.3 and 7.4%, respectively [53], In one series, sur vival was improved compared to a historical series of untreated patients. The survival rate at 2 years was 49% for class A cirrhotics, 29% for class B cirrhotics, and 9% for class C cir rhotics.…”