Reuters Health Information (2006-06-14): Particle embolization aids survival in recurrent hepatocellular carcinoma
Particle embolization aids survival in recurrent hepatocellular carcinoma
Last Updated: 2006-06-14 9:55:23 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Bland particle embolization, i.e., without concurrent chemotherapy, can be an effective salvage strategy in patients who have recurrent hepatocellular carcinoma after hepatectomy, according to New York-based researchers.
As investigator Dr. Yuman Fong told Reuters Health, "Surgical resection can provide potential cure for patients with hepatocellular carcinoma, a disease once thought to be a death sentence. With recent developments in minimally invasive therapies such as particle embolization, even patients who have recurrence after resection can live a long time."
Lead investigator Dr. Anne M. Covey explained further that "there is a controversy in the oncology literature on the relative value of bland embolization that uses tiny particles injected into the arterial supply of tumor to cause ischemic necrosis versus chemoembolization that injects chemotherapy directly into the arteries feeding liver tumors and using large particles to limit the 'wash-out' of chemotherapy from the tumor."
"The latter," she added, "is more expensive, labor intensive and is associated with increased morbidity and has never been shown in a randomized, prospective study to be superior to bland embolization."
To gauge the efficacy of the bland embolization approach, Drs. Covey and Fong and colleagues at Memorial Sloan-Kettering Cancer Center reviewed the records of 45 patients who had undergone the procedure at their institution over a period of about 10 years.
Of these patients, 6 also underwent ablative therapy after embolization, the team notes in the May 15th issue of Cancer. Altogether, the median number of embolization procedures per patient was 3.2 (range, 1 to 14).
The median time to recurrence was 13 months and the median survival after embolization was 46 months. Actuarial survival rates were 86% at 1 year, 74% at 2 years, and 47% at 5 years.
The number of tumors was a prognostic factor. The mortality hazard ratio for patients with five or more tumors at disease recurrence and those with diffuse tumors was 14, compared with patients with only one tumor.
The researchers conclude that "aggressive treatment of disease recurrence with bland embolization may allow a minority of patients to be rendered free of disease and the majority of patients to experience a prolonged survival benefit."