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Triple-Drug Transcatheter Arterial Chemoembolization in Unresectable Hepatocellular Carcinoma: Assessment of Survival in 124 Consecutive Patients

¹ Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125D, Mail Room 1633-B1, Los Angeles, CA 90095-7437.
² Department of Medicine (Hematology-Oncology), David Geffen School of Medicine at UCLA, Los Angeles, CA.
³ Present address: Tower Cancer Research Foundation, Beverly Hills, CA.
⁴ Present address: Amgen, Inc., Thousand Oaks, CA.
⁵ Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.

OBJECTIVE. The objective of our study was to describe survival outcome in 124 patients with unresectable hepatocellular carcinoma treated with triple-drug transcatheter arterial chemoembolization (TACE) using doxorubicin, cisplatin, and mitomycin C using a standardized regimen.

MATERIALS AND METHODS. One hundred twenty-four patients underwent TACE using a standardized triple-drug regimen. Embolization was performed using subselective coaxial embolization technique. Fifty-six patients (group 1) received triple-drug TACE in conjunction with a nonpermanent embolic agent, microfibrillar collagen (Avitene), and 68 patients (group 2) had triple-drug TACE with a permanent embolic agent, Embosphere Microspheres.

RESULTS. Twenty-eight patients underwent liver transplantation after TACE, and survival in these patients was significantly longer than those who did not receive a transplant (p 0.001). The mean survival for the no-transplant group (n = 96) was longer in patients with Child-Pugh class A cirrhosis than in those with Child-Pugh class B cirrhosis (30.3 ± 2.92 [standard error] vs 11.6 ± 2.84 months, respectively; p < 0.001), in those with Okuda stage I versus stage II disease (31.4 ± 3.03 vs 17.4 ± 3.16 months; p = 0.002), and in those with a pre-TACE bilirubin level of less than 2.5 mg/dL (42.75 µmol/L; 28.3 ± 2.75 vs 13.2 ± 3.83 months; p = 0.007). Improved survival was seen in the no-transplant patients receiving TACE with the permanent embolic agent (group 2) than in those receiving TACE with the nonpermanent agent (group 1) out to 30 months (p = 0.002). Complications occurred in 16 patients (12.9%). The 30-day mortality was 2.4%.

CONCLUSION. Patients with hepatocellular carcinoma who underwent triple-drug TACE followed by liver transplantation showed the longest survival. Patients who did not receive a transplant and were treated with triple-drug TACE with a permanent embolic agent showed longer survival to 30 months after TACE than those receiving a nonpermanent embolic agent.

Keywords: hepatocellular carcinoma • liver disease • transcatheter arterial chemoembolization • triple-drug transcatheter arterial chemoembolization

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