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Interventional Radiology for Advanced Hepatocellular Carcinoma: Comparison of Hepatic Artery Infusion Chemotherapy and Transcatheter Arterial Lipiodol Chemoembolization

Shuji Sumie1, Fumihiko Yamashita1, Eiji Ando2, Masatoshi Tanaka2, Yoichi Yano1, Kazuta Fukumori2 and Michio Sata2

1 Department of Medicine, Saga Social Insurance Hospital, 3-8-1, Hyogo-minami, Saga-shi, Saga-ken 849-8522, Japan.
2 Second Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume-shi, Fukuoka-ken 830-0011, Japan.



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  		Fig. 1. —Graph shows comparison of cumulative survival rates between hepatic artery infusion chemotherapy and transcatheter arterial iodized oil (Lipiodol, Guerbet, Aulnay-sous-Bois, France) chemoembolization groups. No significant difference was evident in cumulative survival rates between two groups (p = 0.228). Thick line = hepatic artery infusion chemotherapy (n = 16), thin line = transcatheter arterial Lipiodol chemoembolization (n = 21).

 


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  		Fig. 2. —Graph shows that cumulative survival rates were not significantly different between patients whose tumors were classified as as stage II or stage III (p = 0.837). Thick line = hepatic artery infusion chemotherapy (n = 6), thin line = transcatheter arterial Lipiodol (Guerbet, Aulnay-sous-Bois, France) chemoembolization (n = 9).

 


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  		Fig. 3. —Graph shows that cumulative survival rates tended to be higher in hepatic artery infusion chemotherapy group compared with transcatheter arterial iodized oil (Lipiodol, Guerbet, Aulnay-sous-Bois, France) chemoembolization group in patients who were classified as having tumor stage IV (p = 0.131). Thick line = hepatic artery infusion chemotherapy (n = 10), thin line = transcatheter arterial Lipiodol (Guerbet, Aulnay-sous-Bois, France) chemoembolization (n = 12).

 


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  		Fig. 4. —Graph shows comparison of cumulative survival rates between two groups in those patients whose maximum tumor size was less than or equal to 5 cm. Survival rates were comparable between groups (p = 0.566). Thick line = hepatic artery infusion chemotherapy (n = 11), thin line = transcatheter arterial Lipiodol (Guerbet, Aulnay-sous-Bois, France) chemoembolization (n = 14).

 


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  		Fig. 5. —Graph shows comparison of cumulative survival rates between two groups in those patients whose maximum tumor size was greater than 5 cm. Difference did not reach significant level (p = 0.271), whereas hepatic artery infusion chemotherapy group had higher survival rates than transcatheter arterial iodized oil (Lipiodol, Guerbet, Aulnay-sous-Bois, France) chemoembolization group. Thick line = hepatic artery infusion chemotherapy (n = 5), thin line = transcatheter arterial Lipiodol chemoembolization (n = 7).

 


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  		Fig. 6A. —71-year-old man with advanced hepatocellular carcinoma who was treated by hepatic artery infusion chemotherapy. Contrast-enhanced CT scan obtained before therapy on early phase shows main tumor (thick arrows) of 43 x 37 mm in diameter in segment II and multiple nodules (thin arrows) in both lobes, suggesting intrahepatic metastasis from hepatocellular carcinoma.

 


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  		Fig. 6B. —71-year-old man with advanced hepatocellular carcinoma who was treated by hepatic artery infusion chemotherapy. CT scan obtained before therapy in delayed phase shows that these tumors appear as low-attenuation areas. Thick arrows indicate main tumor, and thin arrows indicate other intrahepatic nodules.

 


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  		Fig. 6C. —71-year-old man with advanced hepatocellular carcinoma who was treated by hepatic artery infusion chemotherapy. CT scan obtained after therapy in early phase shows that main tumor is markedly reduced in size (thick arrows) without contrast enhancement. Note residual enhanced nodule in segment VII (thin arrows) of 20 x 18 mm in diameter.

 


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  		Fig. 6D. —71-year-old man with advanced hepatocellular carcinoma who was treated by hepatic artery infusion chemotherapy. CT scan obtained after therapy in delayed phase shows that residual nodule appears as relative isoattenuation area (thin arrows). Main tumor appears as low-attenuation area (thick arrows).

 

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