Carcinoma, Hepatocellular
Conditions
Brief summary
The objective of this study is to study the safety and tumor response of ACE for large HCC.
Detailed description
Transarterial treatment has been playing an important role in the treatment algorithm for patients with multifocal or large intrahepatic hepatocellular carcinoma not eligible for surgical resection, transplantation, or local ablative therapy. Among the patient group with intermediate tumor stage, in which the tumor dimension exceeds 10cm, the treatment outcome of conventional chemoembolization (cTACE), chemoembolization using drug eluting beads (DEB-TACE) and radioembolization using yttrium 90 is generally unsatisfactory. Some would consider HCC of size \>10cm a relative contraindication for cTACE because of the poor treatment outcome. However, there is no better alternative treatment for local control of these tumors. Ablative chemoembolization (ACE) using Lipiodol-ethanol and anhydrous cisplatin has been found to be highly effective for local control of HCC as compared to cTACE in a case-control study. It is hypothesized that ACE is safe and effective for local control of large HCC of size \>10cm.
Interventions
PROCEDUREAblative chemoembolization (ACE)
Ablative chemoembolization (ACE) using Lipiodol-ethanol and anhydrous cisplatin
Sponsors
Chinese University of Hong Kong
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Use of ACE for HCC of size \> 10cm
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Signage of a written informed consent 2. Age above 18 years 3. HCC unsuitable for resection 4. Child-Pugh A or B cirrhosis 5. Eastern Cooperative Oncology Group performance score 0 or 1 6. No previous treatment with liver resection, ablation, chemotherapy, radiotherapy or transarterial embolization (with or without chemotherapy), 7. HCC diagnosed by typical enhancement patterns on cross sectional imaging or histology. 8. No extra-hepatic involvement on non-enhanced CT thorax and triphasic contrast enhanced CT abdomen. 9. No invasion of portal vein or hepatic vein 10. Massive expansive tumor morphology with measurable lesion on CT (characterized by well-defined spherical or globular configuration, with or without tumor capsule or satellite lesions) 11. Total tumor mass \< 50% liver volume 12. Size of any individual tumor \>10cm in largest dimension
Exclusion criteria
1. History of acute tumor rupture presenting with hemo-peritoneum 2. Biliary obstruction not amenable to percutaneous or endoscopic drainage 3. Child-Pugh C cirrhosis 4. History of hepatic encephalopathy 5. Intractable ascites not controllable by medical therapy 6. History of variceal bleeding within last 3 months 7. Serum total bilirubin level \> 50 umol/L 8. Serum albumin level \< 25g/L 9. INR \> 1.7 10. Serum creatinine level \> 150 mmol/L. 11. Infiltrative tumor morphology (characterized by ill- defined tumor margin and amorphous configuration) or diffuse tumor morphology (characterized by large number of small nodules) 12. Arterio-portal venous shunt affecting \>1 hepatic segment on CT 13. Arterial-hepatic venous shunt with hepatic vein opacified in arterial phase on CT
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to progression | 3 to 6 months after treatment | the interval between the first treatment date and the date of radiological progression, including intralesional progression, extralesional progression, or extra-hepatic progression |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Tumor response | 3 to 6 months after treatment | Tumor response at 3 month and 6 month from the date of first treatment as evaluated by triphasic contrast enhanced CT according to the EASL criteria |
Countries
Hong Kong
Outcome results
None listed