Single- versus Triple-Drug Chemoembolization for Hepatocellular Carcinoma: Comparing Outcomes by Toxicity, Imaging Response, and Survival

• Published in: Journal of vascular and interventional radiology Vol. 27; no. 9; pp. 1279 - 1287
• Main Authors: Mouli, Samdeep, MD, Hickey, Ryan, MD, Thornburg, Bartley, MD, Sato, Kent T., MD, Desai, Kush, MD, Gabr, Ahmed, MD, Kallini, Joseph Ralph, MD, Niemeri, Halla, MD, Kircher, Sheetal, MD, Mulcahy, Mary F., MD, Benson III, Al B., MD, Gupta, Ramona, MD, Salem, Riad, MD, MBA, Lewandowski, Robert J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2016
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic - adverse effects; Chemoembolization, Therapeutic - methods; Chemoembolization, Therapeutic - mortality; Chi-Square Distribution; Chicago; Cisplatin - administration & dosage; Disease Progression; Doxorubicin - administration & dosage; Ethiodized Oil - administration & dosage; Ethiodized Oil - adverse effects; Female; Humans; Kaplan-Meier Estimate; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Male; Middle Aged; Mitomycin - administration & dosage; Multivariate Analysis; Proportional Hazards Models; Radiology; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; World Health Organization; European Association for the Study of the Liver; OS; time to progression; CI; BCLC; Eastern Cooperative Oncology Group; Barcelona Clinic for Liver Cancer; HCC; PVT; TTP; EASL; portal vein thrombosis; ECOG; overall survival; confidence interval; hepatocellular carcinoma; WHO
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2016.01.135

Abstract Purpose To determine the efficacy of single- versus triple-drug chemoembolization for the treatment of hepatocellular carcinoma, as measured by toxicity, tumor response, time to progression (TTP), and overall survival (OS). Materials and Methods A single-center retrospective review was performed on 337 patients who underwent chemoembolization over a 14-year period; 172 patients underwent triple-drug conventional transarterial chemoembolization, and 165 patients underwent single-agent doxorubicin chemoembolization. Imaging characteristics and clinical follow-up after conventional transarterial chemoembolization were evaluated to determine TTP. Imaging response was determined per World Health Organization and European Association for the Study of Liver criteria. OS from time of first chemoembolization was calculated. Results Median TTP was similar between groups: 7.9 months (95% confidence interval [CI], 7.1–9.4) and 6.8 months (95% CI, 4.6–8.6) for triple- and single-drug regimens, respectively ( P > .05). For single-agent conventional transarterial chemoembolization, median OS varied significantly by Barcelona Clinic for Liver Cancer (BCLC) stage: A, 40.8 months; B, 36.4 months; C, 10.9 months ( P < .01). Median OS for triple-drug therapy also varied significantly by BCLC: A, 28.9 months; B, 18.1 months; C, 9.0 months ( P < .01). Single-drug conventional transarterial chemoembolization demonstrated longer median OS compared with triple-drug therapy ( P < .05) for BCLC A/B patients. Conclusions Single-agent chemoembolization with doxorubicin and ethiodized oil demonstrates acceptable efficacy as measured by TTP and OS. Results compare favorably with traditional triple-drug therapy.