Outcome of transcatheter oily chemoembolization in patients with hepatocellular carcinoma

From July 1989 to June 1999, eighty-one patients with hepatocellular carcinoma, 63 males and 18 females, aged 18 to 82 years, were treated with transcatheter oily chemoembolization (TOCE) with an emulsion comprising 10 mL lipiodol and 20 mg mitomycin-C and final embolization with gelfoam particles.

Management began with angiography to identify tumor vascularity followed by TOCE via hepatic artery as peripheral as possible. Initial angiography prior to TOCE revealed both hepatic and extrahepatic collaterals in 11 patients with tumors larger than 10 cm. Following initial TOCE, 48 patients developed intrahepatic collaterals. The remaining 22 patients developed extrahepatic collaterals after 4 sessions of TOCE over a period of about 5 months. Following TOCE, all patients were followed monthly for residual or recurrent tumor. If residual or recurrent tumor was found, TOCE would be repeated at 6-week intervals. The survival of the patients was retrospectively analyzed with respect to the type of hepatic collaterals and completeness of TOCE of extrahepatic collaterals.

The results of the analysis show that the survival times were significantly shorter in patients with both hepatic and extrahepatic collaterals than patients with either extrahepatic collaterals or intrahepatic collaterals; their respective median values (ranges) in months were 8 (4-24), 12.8 (3-48) and 12.5 (13-36). The significant differences in survival times were apparently due to differences in tumor size and stage of disease; their respective tumor sizes (means +/- SD, cm) were 13.6+/-3.9, 9.4+/-4.3 and 10.0+/-3.9. Patients with extrahepatic collaterals and patients with intrahepatic collaterals had similar tumor sizes and survival times. In patients with extrahepatic collaterals, complete TOCE resulted in longer survival time, albeit not statistically significant, than incomplete TOCE.

outcome of TOCE in patients with hepatocellular carcinoma is dependent on tumor size, the stage of disease and completeness of TOCE of extrahepatic collateral vessels.