Hepatocellular Carcinoma
Conditions
Brief summary
The objective of this trial was to evaluate the clinical outcome, treatment toxicity and tumor response of TEA for unresectable HCC.
Detailed description
Transarterial therapy has been playing an important role in the treatment algorithm for patients with multifocal or large intrahepatic lesions not eligible for surgical resection, transplantation, or local ablative therapy. Among the various options of transarterial therapy including chemoembolization (TACE), bland embolization, radioembolization, and TEA, chemoembolization is the only one that has been proven to be of survival benefits versus best supportive care in randomized controlled trials. TEA is a hybrid of bland embolization and chemical ablation. Utilizing a liquid agent of Lipiodol-ethanol mixture consisting of 33% ethanol by volume, TEA offers complete and long lasting embolization of both the arterioles and portal venules supplying the tumor and could possibly be more effective than particulate embolic agents in tumor vessel embolization. The component of ethanol very likely offers synergistic effect to embolization and causes tumor ablation.
Interventions
PROCEDURETEA
Arterial feeders to tumors were identified and catheterized with a microcatheter to a branch supplying a Couinaud segment or subsegmental level for delivery of the therapeutic agent, which was Lipiodol-ethanol mixture at 2:1 ratio by volume for TEA (Lipiodol Ultrafluide, Guerbet, France; Dehydrated alcohol \[absolute alcohol\], Martindale Pharmaceuticals, United Kingdom). The agents were delivered under fluoroscopic control to completely fill up the vasculature of all tumors. The maximum total volume of Lipiodol-ethanol mixture or cisplatin emulsion to be delivered in one treatment session was 60 mL.
Sponsors
Prince of Wales Hospital, Shatin, Hong Kong
Chinese University of Hong Kong
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Signed informed consent by patient * Age above 18 years * Child-Pugh A or B cirrhosis * Eastern Cooperative Oncology Group(ECOG) performance score 2 or below * No serious concurrent medical illness * No prior treatment or surgery for HCC * Histologically or cytologically proven HCC except for lesions of size 1 to 2 cm, with typical features of HCC on two dynamic imaging techniques, or lesions larger than 2cm, with typical features on one dynamic imaging techniques, or lesions larger than 2cm with alpha feto protein(AFP) level \> 200 ng/mL * Unresectable disease without extra-hepatic involvement on chest X-ray(CXR) and CT * Massive expansive tumor type with measurable lesion on CT * Total tumor mass \< 50% liver volume * Tumor size ≤ 15cm in largest dimension * Tumor number ≤ 5
Exclusion criteria
* History of prior malignancy except on the condition that the patient has been disease free for ≥ 3 years * Concurrent ischemic heart disease or heart failure * History of acute tumor rupture presenting with hemo-peritoneum * Serum creatinine level \> 180 umol/L * Biliary obstruction not amenable to percutaneous drainage * Child-Pugh C cirrhosis * History of hepatic encephalopathy * Intractable ascites not controllable by medical therapy * History of variceal bleeding within last 3 months; serum total bilirubin level ≥ 50 umol/L * Serum albumin level \< 25g/L * International normalized ratio(INR) \> 1.5 * Extrahepatic metastasis * Infiltrative or diffuse tumor * Tumor number \> 5 * Thrombosis of target hepatic artery * Partial or complete thrombosis of the main portal vein; tumor invasion of portal branch of contralateral lobe * Hepatic vein tumor thrombus * Significant arterio-portal venous shunt * Significant arterial-hepatic venous shunt
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| overall survival and treatment-related toxicity | Overall survival is studied from treatment to death from any cause, for an estimated period of up to 60 months. Treatment-related toxicity is studied up to 3 months after treatment | Overall survival was defined as date of treatment to date of death from any cause. Patients alive at the end of follow-up were censored. Clinical and laboratory data were documented prospectively at baseline, during hospitalization, and at 7, 14, and 30 day, and 3, 6, 9, and 12 months. Laboratory findings were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events Version 3. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to progression(TTP) | Time to progression is studied from treatment to disease progression, for an estimated period of up to 60 months. | TTP was defined as date of treatment to date of first CT evidence of disease progression. Patient death during follow-up without CT progression was censored. |
| Progression free survival(PFS) | Progression free survival is studied from treatment to disease progression or death from any cause, for an estimated period of up to 60 months. | PFS was defined as date of treatment to date of either first CT evidence of disease progression or death from any cause. Patients alive and free of progression at the end of follow-up were censored. |
| Tumor response | Tumor response is studied at 6 months after treatment | Treatment response of individual treated tumor lesions was evaluated with CT and classified according to a system combining the recommendation of European Association for the Study of the Liver and the guidelines of World Health Organization, which was considered a preferred method of response assessment following transarterial or locoregional therapies for HCC. Tumor response was classified into 4 categories: 1) complete response (CR), 2) partial response (PR), 3) static disease (SD), or 4) intralesional progression. |
Countries
Hong Kong
Outcome results
None listed