According to results published in The Lancet, chemoembolization appears to improve survival in inoperable liver cancer compared to embolization or treatment of symptoms.
Hepatocellular carcinoma (HCC) is a cancer of the liver. The liver is the largest organ in the body and is responsible for over 500 functions, including the secretion of glucose, proteins, vitamins and fats; the production of bile; the processing of hemoglobin and detoxification of numerous substances. Primary liver cancer starts in the cells of the liver and can spread, through blood or lymph vessels, to different parts of the body. Approximately 85% of all primary liver cancers are HCC. HCC treatment depends on the size and number of tumors, condition of the liver, extent of disease and the patient’s age and general health. Treatment may include surgery, radiation therapy, immunotherapy, chemotherapy or a combination of therapies. Since HCC is difficult to diagnose in its earliest stages, long-term survival is poor and recurrence is frequent. Consequently, researchers are often exploring new strategies for the treatment of HCC.
Chemoembolization is a type of treatment that has been evaluated in the treatment of HCC. Chemoembolization involves surgically implanting a catheter into the major artery (hepatic) that supplies blood to the liver. Through this catheter, chemotherapy drugs are injected directly into the liver. This augments the anti-cancer effects of chemotherapy beyond the effects offered by systemic (full body) delivery through a few mechanisms: 1) the chemotherapy agent does not become diluted by mixing with the rest of the blood from the body prior to reaching the cancer, 2) the chemotherapy agent is not broken down in the body through biochemical processes prior to reaching the cancer, 3) larger amounts of the chemotherapy agent can reach the cancer with fewer associated systemic side effects. Following intra-arterial chemotherapy administration, embolization is performed, which involves the placement of a small gelatin sponge into the hepatic artery to block blood flow to the cancer. This reduces the volume of blood in the cancer, which allows the chemotherapy agent to spread throughout the cancer and remain there in sufficient concentrations.
In a recent multi-institutional clinical trial, researchers directly compared different treatment therapies in 112 patients with inoperable HCC. Patients in this trial had cancer that was confined to the liver and had preserved liver function. Patients were treated with either chemoembolization utilizing Adriamycin® (doxorubicin) as the chemotherapy agent, embolization only or treatment to relieve symptoms from the cancer (conservative therapy). When an analysis was performed partway through the trial, researchers discovered that death was reduced by 53% in patients treated with chemoembolization compared to conservative therapy, which resulted in a decision to stop the trial early. Survival at one year following therapy was 82% for patients treated chemoembolization, 75% for patients treated with embolization only and 63% for patients treated with conservative therapy. Survival at two years following therapy was 63% for patients treated with chemoembolization, 50% for patients treated with embolization only and 27% for patients treated with conservative therapy.
The authors of this trial stated that chemoembolization should be considered standard therapy for patients with inoperable, organ-confined HCC and preserved liver function until further confirmatory trials are performed. Patients with inoperable HCC may wish to speak with their physician about the risks and benefits of chemoembolization or the participation in clinical trials further evaluating this procedure.
Reference: Llovet J, Real M, Montana X, et al. Arterial embolization or chemoembolization versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomized uncontrolled trial.
The Lancet. 2002;359:1734-1739.
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