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Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma in Patients with Cirrhosis: Evaluation of Damage to Nontumorous Liver Tissue-Long-term Prospective Study¹

¹ From the Division of Gastroenterology (E.C., D.A.S., M.R.V., G.S.), the Department of Anatomy and Histopathology (S.F.), and the Angiography Service, Department of Diagnostic Imaging (M.N., S.B., F.F.), Ospedale "Casa Sollievo della Sofferenza" IRCCS, I-71013 San Giovanni Rotondo, Foggia, Italy. Received March 10, 1999; revision requested May 21; revision received July 2; accepted July 26. Address reprint requests to E.C.

PURPOSE: To evaluate damage to cirrhotic liver tissue after transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC).

MATERIALS AND METHODS: TACE was performed in 111 patients with HCC that involved less than 30% of the liver. Baseline liver function was evaluated with Child-Pugh scores and other indicators. Eighty-two patients had Child-Pugh class A disease, 27 had class B disease, and two had class C disease. All patients underwent chemotherapy followed by gelatin sponge particle embolization in the proper ("complete" embolization; n = 69) or right or left main ("partial" embolization; n = 42) hepatic artery. Liver function was assessed 4 months later, and 95 patients underwent a second TACE (complete embolization in 57, partial in 38). Liver function was again assessed 4 months later in 60 patients.

RESULTS: No patient died. Child-Pugh scores increased in all patients from a mean 5.96 to 6.28 (not significant) and 6.51 (P = .05) after first and second TACEs, respectively. In patients with class A disease, scores increased from a mean 5.37 to 5.73 (P = .01) and 5.89 (P = .001) after first and second TACEs, respectively; in patients with class B disease, scores changed from a mean of 7.48 to 7.67 and 7.30 after first and second TACEs, respectively (not significant).

CONCLUSION: TACE does not induce significant long-term worsening of liver function in patients with class A or B cirrhosis.

Index terms: Hepatic arteries, therapeutic embolization, 952.1264, 952.1266 • Liver, cirrhosis, 761.794 • Liver neoplasms, 761.323 • Liver neoplasms, chemotherapeutic infusion, 761.1266

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