Christos S. Georgiades MD, PhD, Abstract Co-Author: Nothing to Disclose

Obiora Nnaji, Abstract Co-Author: Nothing to Disclose

Eleni A. Liapi MD, Presenter: Nothing to Disclose

Kelvin Hong MD, Abstract Co-Author: Nothing to Disclose

Ihab R. Kamel MD, PhD, Abstract Co-Author: Nothing to Disclose

Jean-Francois H. Geschwind MD, Abstract Co-Author: Consultant, MDS Inc Grant, MDS Inc Consultant, Biocompatibles International plc Grant, Biocompatibles International plc Research support, Genentech, Inc Grant, Boston Scientific Corporation Consultant, BioSphere Medical, Inc Grant, BioSphere Medical, Inc

Many patients with unresectable HCC referred for TACE treatment are turned away after showing no response to initial TACE. Our objective was to determine whether lack of response to first TACE is predictive of subsequent lack of response and survival benefit in patients with unresectable HCC.

We followed 52 consecutive patients with unresectable hepatocellular carcinoma treated with the Hopkins TACE protocol who received at least two TACE treatments. We used the EASL-criteria to document baseline necrosis and response to subsequent TACE. Tumor necrosis was stratified in quartiles as 0-25%, 26-50%, 51-75% and 76-100% and a patient was branded a "non-responder" if percent necrosis remained within same quartile. We compared EASL-criteria response to second or subsequent TACE and survival between those who showed response to initial TACE and those who did not.

Overall baseline tumor necrosis was 0-25%, which increased to 25-51% and 51-75% after TACE #1 and #2 respectively. There were twenty (38%) non-responders to initial TACE (percent necrosis did not chnage quartile from baseline). Among those, necrosis increased from 0-25% to 51-75% after TACE#2, same as for initial responders. Only 3 of 20 non-responders to initial TACE continued to show lack of response. Additionally, seven of 20 non-responders showed near complete tumor necrosis (76-100%) after TACE #2. There was no difference is survival between initial responders and non-responders.

The majority of non-responders to first TACE (85%) showed the same eventual response and same survival as those who did respond. We recommend that at least two TACE of the same tumor bearing liver lobe/segment be performed prior to abandoning this course of treatment.

38% of patients with HCC show no response to initial TACE. 85% of these patients will enjoy the same survival benefit as those who respond to initial TACE, if the treatment course is continued.

Georgiades, C, Nnaji, O, Liapi, E, Hong, K, Kamel, I, Geschwind, J, Patients with HCC Who Do Not Respond to Initial TACE Show Same Subsequent Response and Enjoy Same Survival Benefit as Initial Responders.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5002278.html