The long-term efficacy of combined chemoembolization and local irradiation in the treatment of patients with large hepatocellular carcinoma.

摘要

BACKGROUND/AIMS: To investigate the effects and toxicity of combined transcatheter arterial chemoembolization and local radiotherapy for patients with unresectable hepatocellular carcinoma. METHODOLOGY: From June 1994 to June 1999, 28 patients with unresectable hepatocellular carcinoma (the largest dimension of tumor ranged from 3 to 10 cm) were treated with transcatheter arterial chemoembolization followed by local irradiation. Response was assessed by computed tomography scan and ultrasound, together with serum alpha-fetoprotein level in cases with increased baseline values. Complications associated with treatment were monitored. Cumulative survival was determined by Kaplan-Meier method from the first day of treatment. RESULTS: An objective response (reduction of tumor area greater than 50%) was achieved in 57.0% of the cases. In 63.0% of the cases with increased alpha-fetoprotein values, alpha-fetoprotein level underwent a marked reduction (more than 50%). The cumulative survival rates at 1, 3, and 5 years were 81.9%, 42.4%, and 21.2%, respectively (median survival, 31 months, 95% CI: 27.8-34.2 months). The combination therapy was generally well tolerated. CONCLUSIONS: The results suggest that combined transcatheter arterial chemoembolization with local radiotherapy is an effective and safe treatment for unresectable hepatocellular carcinoma. Further study is required to compare the therapeutic efficacy of this regimen to transcatheter arterial chemoembolization or radiotherapy alone.