Lipiodolization with or without gelatin sponge in hepatic arterial chemoembolization for hepatocellular carcinoma

Fifty-two patients with unresectable hepatocellular carcinoma were divided into 2 groups. Group A (n = 24) received lipiodolization with gelatin sponge and group B (n = 28) lipiodolization alone. Angiography after hepatic arterial chemoembolization revealed a satisfactory accumulation of lipiodol and obliteration of the microvasculature in the tumors in both groups. However, prolonged obliteration of proximal hepatic arteries was noted in 70%-80% of patients in group A, in contrast to the patency of the arteries in group B. Collateral circulation was found more frequently in group A than in group B, in which recanalization of tumor vessels and phenomenon of iodized oil "wash-out" were seen. There were no significant differences in therapeutic effects in patients with low risk. In those with high risk, the response rates were 28.6% and 64.2%. The half-year survival rates were 28.5% and 62.8%, 1-year survival rates 7.1% and 27.5%, and 2-year survival rates 0% and 13.7% in group A and B respectively. The differences were significant (P < 0.05). Serious complications occurred more frequently in group A than in group B. The therapeutic effects of lipiodolization without gelatin sponge for patients with high risk were significantly superior to those of lipiodolization with gelatin sponge. We conclude that the modality of hepatic arterial chemoembolization should be chosen according to the patient's clinical conditions.