Abstract
Background
Hepatocellular carcinoma (HCC) is a common malignancy worldwide and has a poor prognosis. Although surgery and liver transplantation provide better outcomes, most patients are not candidates due to advanced disease, lack of donor availability, or presence of comorbidities. Several percutaneous approaches such as transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection therapy (PEIT) have been developed for local control and can potentially increase survival in these patients.
Methods
We retrospectively reviewed 33 patients with HCC who were treated with TACE, PEIT, or both from 2000 to 2005 at the VA Caribbean Healthcare System in Puerto Rico to evaluate tolerability, response, and survival. Patients were evaluated with cross-sectional computed tomography imaging to determine response using response evaluation criteria in solid tumors (RECIST).
Results
Thirty-three men with a mean age of 66 years were treated. Mean tumor size was 5.6 cm, ranging from 2 cm to 16 cm. All patients had cirrhosis, with alcohol abuse and hepatitis C as the most common etiologies. Objective radiographic partial response was observed in 28% of patients and 48% had disease stabilization. Most of the patients had a therapeutic response demonstrated by necrosis of the tumor and decreased contrast enhancement. Patients who underwent both TACE and PEIT had a higher response rate and disease stabilization but no difference in survival compared with those who received TACE or PEIT alone. Median survival for the whole group was 2 years. Causes of death included tumor progression, hepatic failure, gastrointestinal bleeding, and infections. The initial tumor size and Child-Pugh class did not confer a significant difference in survival rate.
Conclusions
In Puerto Rico, where liver transplantation is not performed at present, percutaneous treatments are effective local therapies for patients who are not candidates for surgery and who have disease limited to the liver.