Purpose
Transarterial embolization (TAE) with a permanent embolic agent alone carried out through superselective catheterism of the feeding artery, is a potentially radical treatment for hepatocellular carcinoma (HCC). We designed a two phase open pilot study to assess feasibility, tolerability and effectiveness of TAE with microspheres in patients with a HCC and compensated cirrhosis.
Material and methods
In the first phase, we assessed feasibility and objective response, i.e. tumor necrosis at histology, in 5 patients undergoing partial or total hepatectomy. The second phase was to assess TAE effectiveness in 24 consecutive patients (21 with 1 node, 3 with 2 nodes) with Child-Pugh A cirrhosis and a hypervascular HCC of 1.0 to 6.0 cm in size, who were not suitable for surgery or percutaneous interstitial ablation. Microspheres of 40-120 or 100-300 μm (Biosphere Medical, Roissy en France) were injected via superselective catheterization of the node for a maximum of 3 treatments every other month until complete devascularitazion by CT was demonstrated.
Results
. In the first phase, the 3 patients undergoing repeat treatment achieved complete necrosis of the node whereas the 2 patients receiving a single treatment before transplantation achieved 50% necrosis. In the second phase, 21 patients (87%) underwent 1 to 3 cycles (median 1.9) achieving a complete response. The one-year survival was 100% and tumor-free survival was 56%. No patient required analgesics or showed liver deterioration following TAE.
Conclusion
. TAE with microspheres was a well-tolerated and effective treatment for less than 6 cm HCC developing in patients with compensated cirrhosis who were not eligible to surgery or percutaneous interstitial therapies.