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Transcatheter Arterial Chemoembolization Does Not Improve Survival in Liver Cancer Patients Undergoing Chemotherapy

SUMMARY: As a treatment for hepatocellular carcinoma (HCC), (TACE) -- in which patients undergo both infusion of chemotherapy drugs directly into the hepatic artery supplying the liver and embolization, or blockage of small blood vessels -- may be no more effective that chemotherapy infusion alone, according to a study described in the December 2009 Journal of Hepatology.

By Liz Highleyman

Over years or decades, chronic hepatitis B or C can lead to advanced liver disease, including liver cancer. HCC is a difficult form of cancer to treat, in part because it is often diagnosed late.

Infusion of chemotherapy drugs directly into the liver's blood supply has been shown to be effective for HCC, given that liver tumors tend to be highly vascular. The embolization procedure blocks small blood vessels so they cannot carry blood away from the liver -- and tumors therefore receive longer exposure to the drugs -- and so that tumors are deprived of some of their blood supply. However, it is not clear whether TACE lads to better outcomes than transarterial chemotherapy infusion alone.

A technique called transcatheter chemoembolization is used for some patients with liver cancer or other types of cancer that have spread to the liver. The procedure is a way of delivering cancer treatment directly to a tumor through minimally-invasive means.

Takuji Okusaka and colleagues from Japan conducted a multicenter, open-label Phase 3 trial to evaluate the impact of adding embolization on the survival of patients treated with transarterial chemotherapy.

Patients with newly diagnosed unresectable (not removable by surgery) HCC were randomly assigned to undergo treatment using either transarterial infusion alone or TACE.

All participants had the chemotherapy drug zinostatin stimalamer injected into the hepatic artery. Those in the TACE group also had gelatin sponge particles infused to block small vessels. Treatment was repeated if follow-up computed tomography scans showed new liver tumors or re-growth of previously treated tumors.


82 patients were assigned to the transarterial infusion alone group and 79 were assigned to the TACE group; baseline characteristics were comparable in the 2 groups.
At the time of the analysis, 58 patients in the transarterial infusion group and 51 in the TACE group had died.
The median overall survival time was 679 days in the transarterial infusion group compared with 646 days in the TACE group.

Based on these findings, the investigators concluded, "The results of this study suggest that treatment intensification by adding embolization did not increase survival over [transarterial infusion] with zinostatin stimalamer alone in patients with HCC."

Embolization can have adverse effects, including interfering with future attempts at transarterial infusion; these findings suggest that the long-term advantages of TACE do not justify its drawbacks.

National Cancer Center Hospital, Tokyo, Japan; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; Central Hospital and Cancer Center of Ibaraki, Ibaraki, Japan; Gastroenterological Center, Yokohama City University Medical Center, Kanagawa, Japan; Kinki University, Osaka, Japan; Chiba University, Chiba, Japan; Osaka Red Cross Hospital, Osaka, Japan; Kurume University, Fukuoka, Japan; Kumamoto University, Kumamoto, Japan; Ogaki Municipal Hospital, Gifu, Japan; Kyoto University School of Public Health, Kyoto, Japan; Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan; Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan.



T Okusaka, H Kasugai, Y Shioyama, and others. Transarterial chemotherapy alone versus transarterial chemoembolization for hepatocellular carcinoma: A randomized phase III trial. Journal of Hepatology 51(6): 1030-1036 (Abstract). December 2009.

A Forner and JC Trinchet. Transarterial therapies in HCC: does embolization increase survival? Journal of Hepatology 51(6): 981-983. December 2009.






















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