Evaluation of patients undergoing Transarterial Chemoembolization (TACE) for Hepatocellular Carcinoma with respect to tumor size, site and number of lesions

Abstract

TACE is the combination of two procedures, an infusion of the mixture of chemotherapeutic agents (e.g. doxorubicin, cysplatin, or mytomycin C) and hepatic artery embolization in which particles such as polyvinyl alcohol or gelfoam, are injected simultaneously into selected branches of the hepatic artery supplying the tumor. Hepatocellular carcinoma is rarely seen before the age of 40 years and reaches a peak at around 70 years of age. Owing to its multicentricity, large tumor size and pre-existing cirrhosis most of these tumors were deemed unrespectable at the time of diagnosis. The purpose of this study was to evaluate the tumor size, site and number of lesions that is acquired on hepatic angiogram during TACE of the liver, and compare it with the information provided by pre-interventional contrast enhanced CT images as there is a possibility that CT may not show smaller lesions. This study was carried out in the Department of Angiography, Sindh Institute of Urology and Transplantation (SIUT) from May to October 2011. A total of 30 patients was included in the study. All individuals underwent pre-procedural imaging with contrast material, enhanced CT angiography or MR to ensure that the disease was liver-dominant and to visualize the blood vessels of the liver. This study included 30 patients age ranges 40-80 years, 22 of whom were males and 8 of them were females. HCC had been diagnosed in all patients. Each patient underwent selective Hepatic Chemoembolization in either the right, left or in both lobes. . In comparison to CT, the hepatic angiogram showed 14(46.6%)patients having single lesion, 7(23.3%) were having double lesions and 9 (30%) were having multiple lesions. So the overall sensitivity of hepatic angiogram in the detecting number of lesions is 75 % - 80%. The size of ≤2cm HCC was found in 12(35%) patients, HCC >3cm were found in 7(21%) patients and HCC >4cm was found in 15(44.4%) patients. The size of the HCC which we found in most of the patients during our study is >4cm.