Chemoembolisation of hepatocellular carcinomas: personal experience

Transcatheter arterial chemoembolisation (TACE) using antiblastic agents in association with occlusion of tumour-feeding arteries seems currently to be the most suitable treatment for unresectable hepatocellular carcinomas (HCC) larger than 3 cm in diameter. From July 1989 to January 1991, 21 patients with HCC and a previous history of liver cirrhosis were treated by TACE. The drugs used were doxorubicin and mitomycin C mixed with Lipiodol UF. The arterial occlusion was obtained using Gelfoam or Spongostan particles; in 16 patients it was limited to tumour-feeding arteries to avoid diffuse parenchymal liver damage, while in 5 patients either the main right or left hepatic artery was embolised. Three patients were excluded from the study after TACE because of too short a follow-up; 4/18 died within 3–9 months and 14/18 are still alive with follow-up ranging from 3 to 19 months. A tumour size reduction of more than 50% was observed in 9 patients (50%), with a median survival of 9.8 months. Transient and well-controlled side effects (fever, abdominal pain, nausea and vomiting) were related to the post-embolisation syndrome and could be reduced by using a superselective occlusion procedure.