The effect of using different embolic agents on survival in transarterial chemoembolization of hepatocellular carcinoma: gelfoam versus polyvinyl alcohol

PURPOSE

We aimed to compare the effect of using different embolic agents such as gelfoam and polyvinyl alcohol (PVA) on survival, tumor response, and complications in transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) patients.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of 38 inoperable HCC patients who underwent TACE between August 1998 and April 2007. A total of 50 TACE sessions were performed using PVA (n=18) or gelfoam particles (n=20), following the application of 60 mg doxorubicin with 10–20 mL lipiodol emulsion. The PVA and gelfoam groups were compared based on clinical, laboratory, and demographic variables. Survival rates were calculated starting from the first TACE session using the Kaplan-Meier analysis.

RESULTS

There was no significant difference between the survival rates of PVA and gelfoam groups (P = 0.235). Overall survival rates at 12, 24, 36, 48, and 60 months were 55%, 36%, 15%, 7%, and 5%, respectively. Tumor response, age, lipiodol accumulation type, number of HCC foci, complications, and serum alpha-fetoprotein level were significant factors for survival in all patients.

CONCLUSION

Use of gelfoam or PVA as the embolic agent did not have a significant impact on survival. Complete tumor response, intensive lipiodol accumulation in tumor, older age (>60 years), fewer (≤3) HCC foci, and low serum alpha-fetoprotein level (≤400 ng/mL) were found to improve cumulative survival significantly.Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver and the third leading cause of cancer death worldwide. More than 90% of HCC occurs following liver cirrhosis (1). Transplantation, ablative treatments, and surgical resection are considered as curative treatments (2). Unfortunately, only 30% of HCC cases are eligible for these curative treatments at the time of diagnosis, while the majority is diagnosed in advanced stage, beyond the criteria for surgical therapy (3, 4). Transarterial chemoembolization (TACE) remains the most widely used and established palliative treatment in the management of patients with advanced HCC, with proven survival benefits over the best supportive care (5–8). Despite the worldwide acceptance of TACE in the treatment of surgically unresectable HCC, there is still no standard protocol for its use (9). Various TACE techniques which comprise selective or superselective catheterization, different chemotherapeutic regimens (doxorubicin, 5-fluorouracil, cisplatin, mytomycin-c, epirubicin, neocarzinostatin), and different embolization agents can influence the patient outcome (10, 11). Furthermore a previous review stated that polyvinyl alcohol (PVA) particles may be better than gelatin sponge in TACE treatment (12). Thus, the primary aim of our study was to compare the effect of different embolic agents such as PVA and gelfoam on survival and patient outcome in the treatment of surgically unresectable HCC. The secondary aim was to investigate the effect of TACE on survival.