Nonresectable hepatocellular carcinoma: long-term toxicity in patients treated with transarterial chemoembolization--single-center experience

Abstract

Purpose: To determine the toxicity profile of transarterial chemoembolization (TACE) at 6 months and 1 year after treatment in patients with hepatocellular carcinoma (HCC) in a standardized oncology protocol so that TACE could be compared with systemic chemotherapeutic regimens for liver cancer.

Materials and methods: The study was authorized by the institutional review board. Between January 2002 and January 2007, 190 patients (155 men, 35 women; median age, 65 years; age range, 18-84 years) with HCC who underwent TACE treatment were identified from a prospectively collected database. Clinical records of complete blood cell counts and chemical profiles at baseline and at 6 and 12 months after treatment were studied retrospectively. Toxicity was graded according to the common terminology criteria for adverse events (CTCAE). A transition (survival) analysis perspective was used to estimate the distribution of toxicity grades. Patient survival from the first TACE session was calculated with Kaplan-Meier analysis.

Results: Grade 3 or 4 toxicity 6 and 12 months, respectively, after treatment included leukocytopenia (7% and 19%); anemia (9% and 19%); thromobocytopenia (13% and 23%); prolonged activated partial thromboplastin time (8% and 18%); elevated aspartate aminotransferase (15% and 18%), alanine aminotransferase (10% and 18%), and alkaline phosphatase (8% and 18%) levels; hypoalbuminemia (10% and 19%); hyperbilirubinemia (10% and 22%); and alopecia (18%). The cumulative survival rate was 58% at 1 year, 39% at 2 years, and 29% at 3 years. These toxicity rates were considerably lower than those reported after treatment with currently used systemic chemotherapeutic agents.

Conclusion: Study results show that TACE has a favorable long-term toxicity profile in patients with HCC. Data clearly support the role of TACE in the treatment of patients with nonresectable HCC.

Figure 1:

Hematologic toxicities. Histograms show estimated distributions at baseline and at 1 year after first TACE in all 190 patients. Horizontal bar scales convey the distributions of toxicity grades at baseline (bottom scale) and at 1 year (top scale). Vertical bars convey the possible associations between toxicity grades across the two time points. aPTT = activated partial thromboplastin time, Hb = hemoglobin.

Figure 2:

Nonhematologic toxicities. Histograms show estimated distributions at baseline and at 1 year after first TACE in all 190 patients. Horizontal bar scales convey the distributions of toxicity grades at baseline (bottom scale) and at 1 year (top scale). Vertical bars convey possible associations between toxicity grades across the two time points. ALT = alanine aminotransferase, AST = aspartate aminotransferase.

Figure 3:

Overall survival curve for all 190 patients with nonresectable HCC who were treated with TACE.