The Safety and Clinical Outcomes of Chemoembolization in Child-Pugh Class C Patients with Hepatocellular Carcinomas

Abstract

ObjectiveTo evaluate the safety and clinical outcomes of chemoembolization in Child-Pugh class C patients with hepatocellular carcinomas (HCC).Materials and MethodsThe study comprised 55 patients with HCC who were classified as Child-Pugh class C and who underwent initial chemoembolization between January 2003 and December 2012. Selective chemoembolization was performed in all technically feasible cases to minimize procedure-related complications. All adverse events within 30 days were recorded using the Common Terminology Criteria for Adverse Events (CTCAE). The tumor response to chemoembolization was evaluated using the modified Response Evaluation Criteria In Solid Tumors.ResultsThirty (54.5%) patients were within the Milan criteria, and 25 (45.5%) were beyond. The mortality of study subjects at 30 days was 5.5%. Major complications were observed in five (9.1%) patients who were all beyond the Milan criteria: two hepatic failures, one hepatic encephalopathy, and two CTCAE grade 3 increases in aspartate aminotransferase/alanine aminotransferase abnormality. The mean length of hospitalization was 6.3 ± 8.3 days (standard deviation), and 18 (32.7%) patients were discharged on the next day after chemoembolization. The tumor responses of the patients who met the Milan criteria were significantly higher (p = 0.014) than those of the patients who did not. The overall median survival was 7.1 months (95% confidence interval: 4.4-9.8 months).ConclusionEven in patients with Child-Pugh class C, chemoembolization can be performed safely with a selective technique in selected cases with a small tumor burden.

ALBI and P-ALBI grade in Child-Pugh A patients treated with drug eluting embolic chemoembolization for hepatocellular carcinoma

“…(score C), although treatment of Child-Pugh C patients has been reported with acceptable results (204).…”

New intermediate‐stage subclassification for patients with hepatocellular carcinoma treated with transarterial chemoembolization

“…With the development of the TACE technique and devices related to TACE (especially, sophisticated microcatheters with a very small diameter), the incidence of TACE‐related mortality has tended to decrease yearly . TACE can now be performed safely and effectively even in patients with a poor underlying functional reserve, by using superselective or ultraselective techniques . Thus, we believe that decompensated patients with Child B liver function with minor tumour burden should be grouped separately from decompensated patients with Child B with major tumour burden when the BCLC B stage is subclassified in the patient population treated with TACE.…”

Clinical practice of transarterial chemoembolization for hepatocellular carcinoma: consensus statement from an international expert panel of International Society of Multidisciplinary Interventional Oncology (ISMIO)

“…For patients with limited extrahepatic metastasis with liver-dominant disease, who are most likely to die from intrahepatic disease, TACE may still play a role in controlling the intrahepatic tumors (13). For selected Child-Pugh C patients within Milan criteria, TACE is also performed in Asia (14). With the accumulation of clinical evidence, more and more experts are advocating to expand the indications of TACE for selected patients with advanced stage in the BCLC treatment algorithm.…”