Chemoembolization Improves Survival in Liver Cancer

Laurie Barclay, MD

May 21, 2002

NEW YORK (Medscape Wire) May 22 -- Chemoembolization should be the standard approach in selected patients with unresectable hepatocellular carcinoma, based on improved survival in a randomized trial described in the May 18 issue of The Lancet.

"There is no standard treatment for unresectable hepatocellular carcinoma," write Josep Llovet, MD, from the University of Barcelona, Spain, and colleagues. "Arterial embolization is widely used, but evidence of survival benefits is lacking."

In this multicenter trial, investigators randomized 112 cirrhotic patients with unresectable liver cancer to receive arterial embolization using a gelatin sponge to block blood flow to the tumor; chemoembolization using the gelatin sponge plus doxorubicin; or conservative treatment.

When interim analysis showed that chemoembolization reduced mortality by 53% compared with conservative treatment, the trial was stopped. Death occurred in 25 of 37 patients on embolization, 21 of 40 on chemoembolization, and 25 of 35 receiving conservative treatment. One-year survival rate was 75% for embolization, 82% for chemoembolization, and 63% for conservative treatment. Corresponding 2-year survival rates were 50%, 63%, and 27%, respectively ( P=.009). Objective responses to chemoembolization lasted for at least 6 months in 35% of cases, and portal vein invasion was significantly lower with chemoembolization than with conservative treatment.

"While we wait for confirmatory studies and from now on, chemoembolization should become the standard approach for a selected group of candidates (unresectable intermediate hepatocellular carcinoma and preserved liver function)," the authors write.

Lancet. 2002;359:1734-1739

Reviewed by Gary D. Vogin, MD

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