The effect of transarterial chemoembolization therapy to survival in unresectable liver tumors

Öz

Objectives: The aim of this study was to investigate the effect of Transarterial Chemoembolization (TAKE) on tumor response survival in patients with hepatocellular carcinoma (HCC) between January 2002 and December 2008. Materials and methods: In 33 unresectable HCC pa­tients TACE treatment was administered 59 times. Lipi­odol + epirubycin hidrochlorur emulsion and lipiodol were administered to HCC for 1-4 times (mean 1.78) via the hepatic artery, selectively. Patients were examined at 1st, 2nd, and 4th months with abdomen CT, serum albumin, bilirubin, PT, AFP levels. Procedure was repetaed in case of growth in the initial mass size or enhancing solid por­tion of tumor on the CT images. Results: In our study, tumor size above 5 cm, diffuse involvement, ascites, serum albumin level below 2.8 g/dl, bilirubin level above 3 mg/dl, Child C stage, Okuda III stage, serum AFP level above 400 IU/dl and low lipiodol involvement were considered as poor prognostic factors. Tumor size below 5 cm, nodularity, absence of ascites, serum albumin levels above 3.5 g/dl, bilirubin levels be­low 1 mg/dl, Child A stage, Okuda I stage and high lipiodol involvement were found as good prognostic factors. Conclusion: In present study, we found that repetitive TACE procedures improved the survival in selected unre­sectable HCC patients

Anahtar Kelimeler

• Transarterial chemoembolization, HCC, lipi­odol, survival

Cerrahi tedavi yapılamayan primer karaciğer tümörlerinde transarteriyel kemoembolizasyon tedavisinin sağ kalıma etkisi

Öz

Amaç: Bu çalışmanın amacı, Ocak 2002-Aralık 2008 ta­rihleri arasında karaciğer tümörü tanısı alan ve Transar­teryel Kemoembolizasyon (TAKE) tedavisi uygulanan he­patoselüler karsinom (HCC) tanılı hastalarda tümör yanıtı ve tedavinin sağkalıma etkisini araştırmaktır. Gereç ve yöntem: Cerrahi tedavi yapılamayan 33 HCC tanılı olguya 59 defa TAKE tedavisi uygulandı. Hastalara 1-4 defa (ortalama 1.78 kez) lipiodol+epirubicin hidroklo­rür emülsiyonu ile lipiodol hepatik arter yoluyla selektif ola­rak verildi. Hastalar 1, 2 ve 4. ayda abdomen bilgisayarlı tomografi (BT) ve serum albumin, bilirubin, protrombin zamanı (PT), a-fetoprotein (AFP) değerleri ile takip edildi. BT\' de kontrastlanan solid tümör varlığı ve kitle çapı artışı durumlarında işlem tekrar edildi. Bulgular: Çalışmamızda HCC hastalarının tedavi önce­si tümör çapının 5 cm\'den büyük olması, diffüz tutulum olması, asit olması, serum albumin değerinin 2.8 g/dl\'nin altında olması, bilirubin değeri 3 mg/dl\'nin üstünde olma­sı, Child-C evresinde olması, Okuda III evresi ve serum AFP değerinin 400 IU/dl üstünde olması ve lipiodolün az tutulumu kötü prognoz göstergesi olarak saptandı. Tümör boyutu 5 cm\'nin altında olması, nodüler olması, asitin olmaması, hastanın serum albuminin >3.5 mg/dl ve bilirubinin

Anahtar Kelimeler

• Transarteryel kemoembolizasyon, HCC, lipiodol, sağ kalım

Kaynakça

1. Okuda K, Ohtsuki T, Obata H, et al. Natural history of hepa- tocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 1985;4(7):918–27.
2. Okuda K, Liver Cancer Study Group of Japan. Primary liver cancers in Japan. Cancer 1980;45(12):2663–9.
3. Stuart KE, Anand AJ, Jenkins RL. Hepatocellular carcinoma in the United States. prognostic features, treatment out- come, and survival. Cancer 1996;77(11):2217–22.
4. Uchida H, Matsuo N, Nishimine K, Nishimura Y, Sakaguchi H, Ohishi H.Transcatheter arterial embolization for hepato- ma and segmental use. Semin Intervent Radiol1993:12(1): 19-26.
5. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer.1981;47(1):207-14.
6. Nagao T, Panis Y, Farges O, Benhamou JP, Fekete F. Intrahe- patic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg 1991;241(1):114–7.
7. Nagao T, Inoue S, Yoshimi F, et al. Post operative recurrence of hepatocellular carcinoma.Ann Surg 1990;211(1):28–33.
8. Stuart K, Stokes K, Jenkins R, Trey C, Clouse M. Treatment of hepatocellular carcinoma using doxorubicin/ethiodized oil/gelatin powder chemoembolization. Cancer 1993; 72(12): 3202-9.

9. Therasse E, Breittmayer F, Roche A, et al. Transcatheter chemoembolization of progressive carcinoid liver metasta- sis. Radiology 1993;189(4):541–7.
10. Llado’ L, Virgili J, Figueras J, et al. A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization. Cancer 2000; 88(1): 50-7.
11. Lo CM, Ngan H, Tso WK, Liu CL, et al. Randomized con- trolled trial of transarteriyel lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002; 35(5): 1164-71.
12. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoemboliza- tion improves survival. Hepatology 2003;37(3):429–42.
13. Ueno K, Miyazono N, Inoue H, Nishida H, Kanetsuki I, Na- kajo M. Transcatheter arterial chemoembolization therapy using iodized oil for patients unresectable hepatocelluler carcinoma. Cancer. 2000;88(1):50-7.
14. Jhonson PJ, Non-surgiacal treatment of hepatocellular cars- inoma. HPB 2005;7:50-5.
15. Venook AP, Stagg RJ, Lewis BJ, et al. Chemoembolization for hepatocellular carcinoma. J Clin Oncol 1990;8(10):1108- 14.