Evaluation of combined therapy with chemoembolization and irradiation for large hepatocellular carcinoma.

Abstract

The effects of combined transcatheter arterial chemoembolization (TACE) and radiotherapy in patients with large hepatocellular carcinoma (HCC) were analysed retrospectively. A total of 107 patients with large unresectable HCC was treated with TACE followed by external beam irradiation. The largest dimension of the tumours ranged from 5 cm to 18 cm. Acute effects, survival rates, toxicity and prognostic factors were analysed. Follow-up ranged from 4 months to 98 months (median 24 months). An objective response, i.e. reduction of tumour area greater than 50%, was achieved in 48.6% of cases. In 64.9% of the cases with increased alpha-feto protein (AFP) values, AFP level underwent a reduction of more than 25%. The cumulative survival rates at 1, 3 and 5 years were 59.4%, 28.4% and 15.8%, respectively (median survival 18 months). The combination therapy was generally well tolerated. Only two patients died from liver failure or variceal bleeding associated with therapy. The Cox proportional hazards model showed that the number of tumours and the irradiation dose were independent prognostic factors. The results indicate that combined TACE with radiotherapy is a promising therapeutic approach for large unresectable HCC. Prospective controlled trials to ascertain the real potential benefit of this approach are required.

Radiotherapeutic Strategies in the Management of Hepatocellular Carcinoma

“…The difference in survival was greatest for large tumors, with 2-year survival rates of 63 versus 42% in 5- to 7-cm tumors, 50 versus 0% in 8- to 10-cm tumors, and 17 versus 0% in tumors larger than 10 cm, for radiation therapy and TACE, respectively [49]. A similar range of response rates with TACE followed by radiation therapy has been reported by other investigators as well [50,51,52,53]. Overall, following a variety of fractionations and doses in a variety of series, 1-year survival rates ranged from 50 to 95%, and 5-year survival rates ranged from 9 to 25% following 40–60 Gy delivered over 1–5 weeks [54,55,56,57,58].…”

Experimental Therapy of Hepatoma with Artemisinin and Its Derivatives: In vitro and In vivo Activity, Chemosensitization, and Mechanisms of Action

“…The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and other chemicals used in this study were of analytic grade and purchased from Sigma-Aldrich, Inc. Tween 20 was purchased from Promega Corp., and the Annexin V-FITC Apoptosis Detection kit was purchased from BioVision, Inc. The primary antibodies against Bcl-2 (100), Bax (N-20), caspase-3 p20 (N-19), E2F1 (C-20), cyclin D1 (DCS-6), cyclin E (HE12), cyclin-dependent kinase (Cdk) 2 (M2), Cdk4 (H-22), Cip1/p21 (187), Kip1/p27 (C-19), poly(ADP-ribose) polymerase (PARP; H-250), Rb (C-15), MDM2 (SMP14), p53 (Pab1801), glyceraldehyde-3-phosphate dehydrogenase (0411), and h-actin (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) were from Santa Cruz Biotechnology, Inc. The secondary antibodies, horseradish peroxidase -linked anti-mouse immunoglobulin G, antigoat immunoglobulin G, and anti-rabbit immunoglobulin G, were also purchased from Santa Cruz Biotechnology.…”

“…Unfortunately, the activity of single chemotherapeutic agents is limited, with a very low response rate. Moreover, aggressive combination chemotherapeutic regimens have not led to any remarkable improvement in response rates (3,4).…”

Potential Prognostic Benefits of Radiotherapy as an Initial Treatment for Patients with Unresectable Advanced Hepatocellular Carcinoma with Invasion to Intrahepatic Large Vessels

“…RT has also been used to treat PVTT; good outcomes have been obtained without causing serious hepatic problems [19,20,21,22,23,24,25,26]. Computerized techniques such as 3-D conformal RT (3D-CRT) can potentially be used to treat not only PVTT, but also metastatic spread to the HV and IVC in advanced HCC.…”