Transarterial ethanol ablation of hepatocellular carcinoma with lipiodol ethanol mixture: phase II study.

Abstract

PURPOSE:

This prospective trial aimed to evaluate the safety and effectiveness of transarterial ethanol ablation (TEA) of intrahepatic lesions of hepatocellular carcinoma (HCC) with a Lipiodol-ethanol mixture.

MATERIALS AND METHODS:

Seventy-seven patients were recruited and 164 lesions (mean size, 5.2 cm +/- 3.0) were treated. Inclusion criteria included histologic proof of HCC, refusal of (n = 9) or contraindication to (n = 68) surgical resection, Eastern Cooperative Oncology Group performance status no greater than 2, and intrahepatic disease without vascular invasion. The mixture consisted of 33% ethanol by volume, with the total dose of Lipiodol-ethanol mixture limited to 60 mL for each treatment session. The primary endpoint was patient survival. Secondary endpoints were tumor response, adverse effects of treatment, and progression-free survival. Median follow-up time for the whole cohort was 2.3 years.

RESULTS:

Median overall survival was 2.2 years. Overall survival and progression-free survival rates at 1 year and 2 years were 77.9% and 50.1% and 63.6% and 46.3%, respectively. Complete ablation according to radiologic criteria was achieved in 61 patients (79.2%) and 86% of the 164 treated lesions. Mean tumor volume reduction was 65.22%. Patient survival was significantly better in patients with tumors no larger than 5 cm (Cox proportional-hazards regression, P = .0074). Treatment response was significantly better for patients with tumors no greater than 7 cm (chi2 test, P = .0462; Fisher exact test, P = .0326). Adverse effects included irreversible hepatic decompensation (0.6% of procedures), pain (4.8%), and fever (13.8%).

CONCLUSIONS:

TEA is a safe and effective means to establish local control of unresectable and resectable intrahepatic lesions of HCC.

• Authors: Simon C H Yu, Edwin P Hui, John Wong, Herman Wong, Frankie Mo, Simon S M Ho, Yuen Y Wong, Winnie Yeo, Paul B S Lai, Anthony T C Chan, Tony S K Mok
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 19 Issue 1 Pg. 95-103 (Jan 2008) ISSN: 1051-0443 [Print] United States
• PMID: 18192473 (Publication Type: Clinical Trial, Phase II, Journal Article)

Chemical References

• Ethanol
• Iodized Oil

Topics

• Adult
• Aged
• Aged, 80 and over
• Angiography, Digital Subtraction
• Carcinoma, Hepatocellular (blood supply, diagnostic imaging, mortality, therapy)
• Chemoembolization, Therapeutic (adverse effects, methods)
• Disease-Free Survival
• Ethanol
• Female
• Humans
• Iodized Oil (administration & dosage)
• Liver Neoplasms (blood supply, diagnostic imaging, mortality, therapy)
• Male
• Middle Aged
• Proportional Hazards Models
• Prospective Studies
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome