Comparison of two Transarterial Chemoembolization Strategies for Hepatocellular Carcinoma

Aim: This retrospective study aimed to compare the efficacy of and tolerance to two center-related conventional transarterial chemoembolization (TACE) strategies in the management of unresectable hepatocellular carcinoma (HCC). Patients and Methods: All HCC patients in whom TACE was initiated in the two centers from June 2008 to July 2011 were included. The TACE strategy performed in center I was ``on demand'' with selective injections of idarubicin, whereas the TACE strategy in center 2 was based ``on scheduled'' nonselective injections of epirubicin. Toxicity was evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events v4.0. Results: One hundred and fifty HCC patients were included. Median time to treatment failure was significantly higher in center 1, 13.1 months vs. 7.9 months in center 2 (hazard ratio, 2.32; p<10-3 in multivariate analysis). Median overall survival was 21.1 months in center 1 vs. 18.4 months in center 2 (p=NS). The proportion of grade >= 3 adverse events and mean hospitalisation duration for the overall TACE treatment were significantly greater in center 2 than in center 1:56% vs. 32% (p<0.01) and 14.2 +/- 7.2 days vs. 103 +/- 7.0 days (p<0.01), respectively. Conclusion: Our results failed to show any significant survival differences between two center-related TACE strategies but showed a significantly smaller proportion of grade >= 3 adverse events and shorter hospitalisation for the overall treatment when the ``on-demand'' strategy was used.