Christos S. Georgiades MD, PhD, 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

Our hypothesis was that patients with unresectable HCC who show deterioration of their Child-Pugh stage (but still remains within TACE inclusion criteria) over the course of TACE treatment have a worse outcome than those who do not, and therefore further TACE should be avoided.

Eighty consecutive patients with Child-Pugh A or B, unresectable HCC, treated with Hopkins protocol TACE were followed to expiration. C-P stage was calculated at baseline and prior to every TACE thereafter. We grouped patients who had C-P deterioration and those who did not and calculated their survival. Among those who had C-P deterioration, we identified two distinct subgroups: one that had C-P deterioration and expired prior to next TACE and one that despite C-P deterioration survived and were able to receive further treatment (no new exclusion criteria i.e. Child-Pugh C). We calculated and compared the survival of these two subgroups.

Overall median survival was 57+42 weeks. Survival of those patients who did not show C-P deterioration during treatment was 48+36 weeks (n=35, 44%, median TACE=2) whereas survival for those who showed C-P deterioration was 64+46 weeks (n=45, 56%, median TACE=3). From the latter group, survival for those who expired after C-P deterioration without receiving further TACE was 63+43 weeks (n=38, 84%) and 88+55 weeks for those who showed C-P deterioration but received additional TACE (n=7, 16%).

Best survival (88 weeks) was shown for those patients who received more TACE and despite C-P deterioration during treatment period, continued to be treated. Worst survival was noted for those who showed no C-P deterioration and fewer TACE. This is the opposite of our hypothesis. This unexpected result suggests that patients with unresectable HCC and C-P A or B cirrhosis benefit from continued aggressive treatment. One possible explanation is that C-P A or B patients are more likely to die from HCC-related complications rather than cirrhosis.

Despite worsening liver function, as long as Child-Pugh stage remains A or B, patients with unresectbale HCC can derive survival benfit from TACE.

Georgiades, C, Liapi, E, Hong, K, Kamel, I, Geschwind, J, Continued Aggressive TACE Treatment for Unresectable HCC Despite Child-Pugh Deterioration Correlates with Better Survival for Stage A or B Patients.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5002287.html