Chemoembolisation Adds Survival Time In Untreatable Liver Cancer
Eine DGReview von : "Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial" Lancet
Chemoembolisation as treatment for patients with liver cancer that cannot be treated surgically or by transplantation could increase survival by two years.
The procedure blocks blood supply to the tumour through use of a gelatin sponge with doxorubicin chemotherapy to inhibit cancer growth.
Researchers with the Barcelona Clinic Liver Cancer (BCLC) Group in Spain stopped a randomised, controlled trial in 112 patients after four years when the ninth sequential inspection showed that chemoembolisation had survival benefits compared with conservative treatment.
Dr. Jordi Bruix of the Barcelona Hospital Clinic Digestive Disease Institute says: "While we wait for confirmatory studies and from now on, chemoembolisation should become the standard approach for a selected group of candidates." He includes patients with unresectable intermediate hepatocellular carcinoma and preserved liver function in this group of patients.
The BCLC study also included an embolisation treatment group, with embolisation defined as regularly repeated arterial embolisation through use of a gelatin sponge.
Of 35 patients assigned conservative treatment, 25 had died at four years. This compared to 21 deaths among 40 patients assigned to chemoembolisation and 25 deaths among 37 patients assigned to embolisation.
Benefits in survival were ascribed to the restrictive selection of trial candidates and to the relevant response to treatment and its maintenance. Only 12 percent of 903 assessed patients met inclusion criteria. Those excluded had factors associated with treatment intolerance or failure, tumour-related symptoms, diffuse neoplasm, renal failure Child-Pugh c class disease or portal or segmental thrombosis.
Hazard rate of death in the chemoembolisation group was 0.47 when the trial was stopped.
Survival probabilities for chemoembolisation were 82 percent at one year and 63 percent at two years. For embolisation, the probabilities were 75 percent at one year and 50 percent at two years.
For conservative treatment, the probabilities were 63 percent at one year and 27 percent at two years.
Lancet, 2002; 359: 1734-1739. "Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial"