Transarterial chemoembolization for hepatocellular carcinoma: volumetric and morphologic CT criteria for assessment of prognosis and therapeutic success-results from a liver transplantation center.

Abstract

To evaluate the prognostic value of volumetric computed tomography (CT) for therapy control in patients treated with repeated transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Eighty-five patients with histologically proved HCC underwent 182 TACE procedures with 50 mg/m(2) doxorubicin hydrochloride, 50 mg/m(2) cisplatin, 10 mL/m(2) iodized oil, and amilomer microspheres. The volumes of liver and tumor were measured with a region-of-interest CT technique. Iodized oil retention was estimated with CT performed 24-48 hours after treatment. Tumor volume expressed as a percentage of liver volume was less than 5% in 26, less than 15% in 33, and 15% or greater in 26 patients. The overall 1-year survival rate was 57.6% (mean, 534 days; median, 428 days). There was a statistically significant prolongation of survival when the tumor volume was less than 200 mL (P <.02) and less than 5% of the liver volume (P <.01). Complete (>/=75%) and good (50%-74%) iodized oil retention raised the median survival significantly (P <.001 and P <.07, respectively). Significantly reduced survival correlated with diffuse tumor growth pattern (P <.05) and presence of more than nine lesions (P <.03). TACE resulted in significant prolongation of survival in patients with tumor volumes of less than 200 mL, tumor-to-liver volume ratios of less than 5%, and iodized oil retention greater than or equal to 75%.