Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: Results of a randomized, controlled trial in a single institution

TLDR

The study evaluated whether transarterial embolization (TAE) without chemotherapy improves survival in patients with nonsurgical hepatocellular carcinoma. Eighty patients were randomized to TAE (n = 40) or symptomatic care (n = 40), with comparable liver function and tumor stage across groups. TAE yielded a 55 % partial response rate and reduced tumor progression (57 % vs 77 % at 1 year) but did not improve overall survival (49 % vs 50 % at 2 years, 13 % vs 27 % at 4 years) or increase complications, with 82 % experiencing self‑limited post‑embolization syndrome and no treatment‑related deaths.

Abstract

This randomized, controlled trial assessed the effect of transarterial embolization (TAE) (without associated chemotherapy) on the survival of patients with nonsurgical hepatocellular carcinoma (HCC). Eighty consecutive patients were randomized to treatment with embolization (Group A, n = 40), or to symptomatic treatment (Group B, n = 40), there being no differences between both groups regarding the degree of liver function impairment and tumor stage. Eighty-two percent of the patients presented a self-limited postembolization syndrome, without treatment-related mortality. Fifty-five percent of the treated cases exhibited a partial response, which resulted in a lower probability of tumor progression during follow-up (57% vs. 77% at 1 year; P < .005). However, after a median follow-up of 24 months (30 deaths in each group), there are no differences in survival (Group A: 49% and 13%; Group B: 50% and 27%, at 2 and 4 years, respectively; P = .72). The absence of differences was maintained even when dividing patients according to Child-Pugh’s grade, Okuda stage, or performance status test (PST). Furthermore, there were no differences in the probability of complications or in the need of hospital admissions. In conclusion, TAE has a marked antitumoral effect associated to a slower growth of the tumor, but it does not improve the survival of patients with nonsurgical HCC.