The effect of using different embolic agents on survival in transarterial chemoembolization of hepatocellular carcinoma: gelfoam versus polyvinyl alcohol

Abstract

ORIGINAL ARTICLE PURPOSE We aimed to compare the effect of using different embolic agents such as gelfoam and polyvinyl alcohol (PVA) on survival, tumor response, and complications in transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) patients. MATERIALS AND METHODSWe retrospectively reviewed the medical records of 38 inoperable HCC patients who underwent TACE between August 1998 and April 2007. A total of 50 TACE sessions were performed using PVA (n=18) or gelfoam particles (n=20), following the application of 60 mg doxorubicin with 10-20 mL lipiodol emulsion. The PVA and gelfoam groups were compared based on clinical, laboratory, and demographic variables. Survival rates were calculated starting from the first TACE session using the Kaplan-Meier analysis. RESULTSThere was no significant difference between the survival rates of PVA and gelfoam groups (P = 0.235). Overall survival rates at 12, 24, 36, 48, and 60 months were 55%, 36%, 15%, 7%, and 5%, respectively. Tumor response, age, lipiodol accumulation type, number of HCC foci, complications, and serum alpha-fetoprotein level were significant factors for survival in all patients. CONCLUSIONUse of gelfoam or PVA as the embolic agent did not have a significant impact on survival. Complete tumor response, intensive lipiodol accumulation in tumor, older age (>60 years), fewer (≤3) HCC foci, and low serum alpha-fetoprotein level (≤400 ng/mL) were found to improve cumulative survival significantly.

Minimal invasive treatments for liver malignancies

“…Within the United States, combination therapy is more commonly used, typically consisting of doxorubicin, mitomycin C, and cisplatin. Furthermore, similar survival benefit has been found using temporary or permanent embolic agents for cTACE [75]. Lack of standardization is the most problematic issue to definitively define the cTACE treatment efficacy in different subgroups of patients.…”

Transcatheter arterial embolization in normal canine liver

“…Our results are similar, as recanalization occurred within 2 weeks after arterial embolization in dogs. Further studies are needed to determine whether alternative agents such as polyvinyl alcohol and microspheres would extend the duration of occlusion in canine livers although the necessary duration of vascular occlusion to induce tumor necrosis is unknown …”

Transarterial Embolization for Hepatocellular Carcinoma: A Comparison between Nonspherical PVA and Microspheres

“…Permanent or semipermanent arterial occlusion can be achieved with different agents such as Gelfoam, PVA, ME, and more recently drug-eluting beads (DEB-TACE). Nevertheless, there is little evidence in the literature comparing the efficiency between different embolizing agents especially for TAE [ 16 ]. Although Gelfoam has been considered as a suboptimal agent, due to the large size of the particles (1 mm) and temporary occlusion of the feeding arteries that only lasts for 2 weeks, similar survival rates have been demonstrated when Gelfoam was compared with PVA in HCC patients treated with TACE [ 16 , 17 ].…”

“…Nevertheless, there is little evidence in the literature comparing the efficiency between different embolizing agents especially for TAE [ 16 ]. Although Gelfoam has been considered as a suboptimal agent, due to the large size of the particles (1 mm) and temporary occlusion of the feeding arteries that only lasts for 2 weeks, similar survival rates have been demonstrated when Gelfoam was compared with PVA in HCC patients treated with TACE [ 16 , 17 ]. Recently, a randomized controlled study showed no significant difference in 1-year survival when DEB-TACE was compared with bland embolization with ME [ 12 ].…”