Transcatheter Arterial Chemoembolization And Combined With Intensity-modulated Radiotherapy In Patients With Primary Hepatic Carcinoma

Part Ⅰ: Prospective controlled trial of transcatheter arterial chemoembolization (TACE) combined with intensity-modulated radiotherapy (IMRT) for primary hepatic carcinoma.Objective: To investigate the effect of transcatheter arterial chemoembolization (TACE) combined with intensity-modulated radiotherapy (IMRT) on inoperable primary hepatic carcinoma.Methods: Seventy-two patients of inoperable primary hepatic carcinoma were prospectively devided into TACE+IMRT group (combined group,32patiens) and TACE group alone (TACE group,40patiens). The data of two group had comparability. Results: The overall6-,12-and18-month survival rate was100%,90.6%,and68.7%in the combined group, and92.5%.70.0%.47.5%in the TACE group. The difference between the two groups was significant(χ2=4.77.P=0.029). The effective rate of combined group was68.8%), and that of TACE group was42.5%, and the difference was significant (χ2=8.89,P=0.031). The decrease range of AFP in combined group was more than TACE group (χ2=4.06,P=0.044). Multivariable analysis showed that the different groups, BCLC staging and the type of lipiodol retention were independent prognostic factors.There was no treatment-related death. The incidence of adverse effect (combined group) was low, two patients(6.25%>) developed radition-induced liver disease (RILD) that of the liver function recovered to the normal level after eight months.Conclusion: Transcatheter arterial chemoembolization combined with intensity-modu-lated radiotherapy is more effective than Transcatheter arterial chemoembolization alone on inoperable primary hepatic carcinoma, and with a low incidence of adverse effect. Part Ⅱ:Treatment of Primary Hepatic Carcinoma by Transcatheter Arterial Chemoembolization with Sodium Alginate MicrospheresObjective:To investigate the effect of transcatheter arterial chemoembolization (TA CE) with sodium alginate microspheres (KMG) on inoperable primary hepatic carcinoma.Methods:The clinical data of62patients who had inoperable primary hepatic carcinoma and were treated by TACE with KMG were retrospectively reviewed.Results:The overall1-,2-and3-year survival rate was80.6%,51.6%and38.7%, respectively. Multivariable analysis showed that BCLC staging (χ2=9.12, P=0.003) and portal vein tumor thrombus (χ2=8.322,P=0.004) were independent prognostic factors. The common adverse effect after TACE were abdominal pain (64.3%), vomiting (41.3%) and fever (51.1%). The hepatic fuction (ALT. AST and TBIL) transiently increased in post-treatment1day, and recovered to the normal level after one month. There were no significant changes in liver function grade (χ2=1.88, P=0.17). There was no treatment-related death.Conclusion:Transcatheter arterial chemoembolization with sodium alginate microspheres (KMG) is safe and effective on inoperable primary hepatic carcinoma, and its use is recommended. Part III:Hepatic functional reserve and prognosis of primary hepatic carcinoma after transcatheter arterial chemoembolization:evaluated by hepatic cirrhosis gradeObjective:To investigate the effect of hepatic cirrhosis grade in assesment of hepatic functional reserve and prognosis of primary hepatic carcinoma after transcatheter arterial chemoembolization(TACE).Methods:The clinical data of56patients who had inoperable primary hepatic carcinoma after repeated transarterial chemoembolizations (≥8times) were analyzed retrospectively with Child-push grade, CT grade of hepatic cirrhosis and effects.Results:After repeated transcatheter arterial chemoembolizations, there were significant differences in Child-Push grade (χ2=9.57, P=0.008), and hepatic cirrhosis significantly aggravated (χ2=39.13, P=0.000). Median survival time was40months from the first TACE. Log-rank analysis showed that BCLC staging (χ2=15.267, P=0.000). CT grade of hepatic cirrhosis (χ1=17.176, P=0.000), portal vein tumor thrombus (χ2=3.388, P=0.049) and the type of lipiodol retention (χ1=17.895,P=0.000) were the factors effecting prognosis. Multivariable analysis showed that BCLC staging (χ2=7.646, P=0.006) and CT grade of hepatic cirrhosis (χ2=12.609, P=0.000) were independent prognostic factors.Conclusion:Transcatheter arterial chemoembolization is effective in treatment of patients with inoperable primary hepatic carcinoma, but it can aggravate hepatic cirrhosis. CT grade of hepatic cirrhosis is independent prognostic factor. CT grade of hepatic cirrhosis combined with Child-Push grade cirrhosis have important values in evaluating the hepatic functional reserve and prognosis.