Recently, it has been demonstrated that TACE improves survival compared with best supportive care in meta-analyses of randomized trials and in two individual clinical trials. However, although selective TACE is currently widely used, there are no reported extensive data from large series on both short and long term effects of this treatment on liver function. Equally, because the optimal number of sessions is not known, it is debatable if repeated courses of selective TACE may progressively impair liver function and if they are well tolerated or are limited by major side effects.
A research article to be published on April 21, 2009 in World Journal of Gastroenterology addresses this question. The research group, guided by Dr. Sacco from the Gastroenterology Department of Pisa University Hospital, has performed a prospective cohort study on a large group of patients affected by HCC, prospectively evaluating the short and long term impact of selective TACE on liver function. Side effects of treatments were also assessed and the overall survival and progression free survival probabilities were analyzed.
This single center study is very interesting because it evaluates, in a very large population of patients, the effective clinical impact of TACE procedure. This technique, although not included in the number of curative techniques for HCC, has proved to be efficacious in prolonging life expectancy in patients affected by primary liver cancer. Nevertheless many questions remain a matter of debate: how many times can we repeat this treatment without reducing liver function? Is there any difference between multitreated patients and subjects at the first treatment? What is the real life expectancy and HCC progression free survival probability?
This study demonstrates that in a two year period with a well selected population of HCC patients, TACE treatments are really well tolerated without any sensible reduction of liver function, with a low rate of side effects and complications and excellent survival perspectives. One of the most interesting parameters evaluated is the HCC progression free survival probability: the excellent results (69% at two years) confirm the efficacy of this treatment with more than two thirds of patients in a stable clinical condition at the end of the study period. The proper selection of candidates for TACE appears to be a key point in this study: even if a consensus has not yet been reached, the best candidates for TACE seem to be asymptomatic patients with preserved liver function without vascular invasion or extrahepatic tumour spread. Patients suitable for TACE were selected using Child-Pugh, CLIP and BCLC staging systems: these scoring systems have been developed in the past years in order to achieve the best predictive power. In this study these systems are used in conjunction and results obtained seem to demonstrate that this is a real prospect for the future. TACE was repeated "on demand", when there was evidence of insufficient tumor response, tumor recurrence or disease progression. According to data shown, this type of treatment schedule may help preserving liver function and can be well tolerated in elderly patients, often suffering from co-morbidities, as well as in patients previously treated with other therapeutic techniques.
In conclusion, on the basis of Dr. Sacco study results, in a strict selected patient population, TACE is a safe and efficacious procedure in the treatment of HCC. At this time, further studies are warranted to consider the clinical impact of new methods of chemoembolization using drug-eluting particles, which could allow larger tumor necrosis with reduced systemic effects.
Reference: Sacco R, Bertini M, Petruzzi P, Bertoni M, Bargellini I, Bresci G, Federici G, Gambardella L, Metrangolo S, Parisi G, Romano A, Scaramuzzino A, Tumino E, Silvestri A, Altomare E, Vignali C, Capria A. Clinical impact of selective transarterial chemoembolization on hepatocellular carcinoma: A cohort study. World J Gastroenterol 2009; 15(15): 1843-1848
http://www.wjgnet.com/1007-9327/15/1843.asp
Correspondence to: Rodolfo Sacco, MD, PhD, Gastroenterology Department, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy. r.sacco@ao-pisa.toscana.it
Telephone: +39-50-997411 Fax: +39-50-997412
Journal
World Journal of Gastroenterology