Clinical study
Embolization Efficacy and Treatment Effectiveness of Transarterial Therapy for Unresectable Hepatocellular Carcinoma: A Case-Controlled Comparison of Transarterial Ethanol Ablation with Lipiodol–Ethanol Mixture versus Transcatheter Arterial Chemoembolization

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Purpose

To compare the embolization efficacy and treatment effectiveness of transarterial ethanol ablation (TEA) versus those of chemoembolization and evaluate the correlation between embolization efficacy and treatment effectiveness of these treatments for hepatocellular carcinoma (HCC).

Materials and Methods

A case-controlled study was undertaken with 30 patients in each group matched based on Child-Pugh grade, tumor characteristics, and performance status. Primary endpoints were embolization efficacy (ie, Lipiodol retention within tumor at 2 months) and treatment effectiveness as evaluated by tumor response, disease progression, progression-free survival, and overall survival. The secondary endpoint was correlation between embolization efficacy and treatment effectiveness.

Results

Lipiodol retention was greater in the TEA group (89.5% ± 10.7% vs 47.5% ± 21.2%; P < .0001). The tumor progression rate at 1 year was higher in the chemoembolization group (five of 30 vs zero of 30; P = .0261). One- and 2-year overall survival rates were higher in the TEA group (93.3% and 80.0%, respectively, vs 73.3% and 43.3%, respectively; P = .0053). One- and 2-year extrahepatic disease progression rates were lower in the TEA group (P = .0002). There were no differences in progression-free survival and intrahepatic disease progression rates at 1 and 2 years. Patients with greater Lipiodol retention (ie, >60%) had better treatment outcomes at 1 year than those with lesser retention, with higher overall survival rates (88.9% vs 66.7%; P = .0192), lower intrahepatic disease progression rates (25.6% vs 59.4%; P = .0169), lower extrahepatic disease progression rates (0.31% vs 35.5%; P = .0047), and higher progression-free survival rates (72.1% vs 36.3%; P = .005).

Conclusions

The embolization efficacy and treatment effectiveness of TEA are probably superior to those of chemoembolization for HCC.

Section snippets

Study Design

The present study was a case-controlled study of 60 patients with unresectable HCC treated with transarterial therapy. A group of 30 patients who received Lipiodol–ethanol treatment between March and December 2002 was compared with a group of 30 patients who received chemoembolization in 2005. Institutional review board approval was obtained for phase I and II studies of Lipiodol–ethanol treatment, as well as for the comparative study of Lipiodol–ethanol treatment versus chemoembolization. The

Results

When comparing Lipiodol–ethanol versus chemoembolization, the degree of Lipiodol retention in tumor at 2 months was significantly higher in the Lipiodol–ethanol group than in the chemoembolization group (89.5% ± 10.7% vs 47.5% ± 21.2%; P < .0001; Table 1). Tumor response to treatment at 1 year or less—expressed in a ratio of patients showing partial response versus static disease versus lesion size progression—were 18/12/0 in the Lipiodol–ethanol group and 12/13/5 in the chemoembolization

Discussion

The goals of chemoembolization are to deliver a highly concentrated dose of chemotherapy to tumor cells, to prolong the contact time between the chemotherapeutic agents and the tumor cells, and to minimize systemic toxicity from the chemotherapeutic agents (16). Lipiodol is a key ingredient in the treatment protocol of chemoembolization, as it serves the functions of a drug-carrying, tumor-seeking, and embolizing agent. The deliverable chemoembolization agent is prepared in the form of an

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    None of the authors have identified a conflict of interest.

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