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Transarterial Chemoembolization for Hepatocellular Carcinoma: Volumetric and Morphologic CT Criteria for Assessment of Prognosis and Therapeutic Success-Results from a Liver Transplantation Center¹

¹ From the Department of Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Theodor-Stern-Kai 7, 63590 Frankfurt, Germany (T.J.V., M.T., H.S., M.M., J.S.); and the Departments of Radiology (A.S., R.F.) and Surgery (P.N.), Humbolt-University of Berlin, Germany. Received January 20, 1999; revision requested March 22; revision received May 6; accepted July 30. Address reprint requests to T.J.V. (e-mail: T.Vogl@em.uni .Frankfurt.de).

PURPOSE: To evaluate the prognostic value of volumetric computed tomography (CT) for therapy control in patients treated with repeated transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).

MATERIALS AND METHODS: Eighty-five patients with histologically proved HCC underwent 182 TACE procedures with 50 mg/m² doxorubicin hydrochloride, 50 mg/m² cisplatin, 10 mL/m² iodized oil, and amilomer microspheres. The volumes of liver and tumor were measured with a region-of-interest CT technique. Iodized oil retention was estimated with CT performed 24–48 hours after treatment.

RESULTS: Tumor volume expressed as a percentage of liver volume was less than 5% in 26, less than 15% in 33, and 15% or greater in 26 patients. The overall 1-year survival rate was 57.6% (mean, 534 days; median, 428 days). There was a statistically significant prolongation of survival when the tumor volume was less than 200 mL (P < .02) and less than 5% of the liver volume (P < .01). Complete (75%) and good (50%–74%) iodized oil retention raised the median survival significantly (P < .001 and P < .07, respectively). Significantly reduced survival correlated with diffuse tumor growth pattern (P < .05) and presence of more than nine lesions (P < .03).

CONCLUSION: TACE resulted in significant prolongation of survival in patients with tumor volumes of less than 200 mL, tumor-to-liver volume ratios of less than 5%, and iodized oil retention greater than or equal to 75%.

Index terms: Arteries, therapeutic embolization, 952.1264, 952.1266 • Computed tomography (CT), volume rendering, 761.12111, 761.12112, 761.12115 • Liver neoplasms, 761.323 • Liver neoplasms, chemotherapeutic embolization, 761.1266, 952.1266 • Liver neoplasms, CT, 761.12111, 761.12112, 761.12115

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