Transarterial Ethanol Ablation(TEA) for Unresectable Hepatocellular Carcinoma(HCC)

Not Applicable

Completed

Brief Summary: The objective of this trial was to evaluate the clinical outcome, treatment toxicity and tumor response of TEA for unresectable HCC.

Detailed Description: Transarterial therapy has been playing an important role in the treatment algorithm for patients with multifocal or large intrahepatic lesions not eligible for surgical resection, transplantation, or local ablative therapy. Among the various options of transarterial therapy including chemoembolization (TACE), bland embolization, radioembolization, and TEA, chemoembolization is the only one that has been proven to be of survival benefits versus best supportive care in randomized controlled trials. TEA is a hybrid of bland embolization and chemical ablation. Utilizing a liquid agent of Lipiodol-ethanol mixture consisting of 33% ethanol by volume, TEA offers complete and long lasting embolization of both the arterioles and portal venules supplying the tumor and could possibly be more effective than particulate embolic agents in tumor vessel embolization. The component of ethanol very likely offers synergistic effect to embolization and causes tumor ablation.

Recruitment & Eligibility

Inclusion Criteria

Signed informed consent by patient
Age above 18 years
Child-Pugh A or B cirrhosis
Eastern Cooperative Oncology Group(ECOG) performance score 2 or below
No serious concurrent medical illness
No prior treatment or surgery for HCC
Histologically or cytologically proven HCC except for lesions of size 1 to 2 cm, with typical features of HCC on two dynamic imaging techniques, or lesions larger than 2cm, with typical features on one dynamic imaging techniques, or lesions larger than 2cm with alpha feto protein(AFP) level > 200 ng/mL
Unresectable disease without extra-hepatic involvement on chest X-ray(CXR) and CT
Massive expansive tumor type with measurable lesion on CT
Total tumor mass < 50% liver volume
Tumor size ≤ 15cm in largest dimension
Tumor number ≤ 5

Exclusion Criteria

History of prior malignancy except on the condition that the patient has been disease free for ≥ 3 years
Concurrent ischemic heart disease or heart failure
History of acute tumor rupture presenting with hemo-peritoneum
Serum creatinine level > 180 umol/L
Biliary obstruction not amenable to percutaneous drainage
Child-Pugh C cirrhosis
History of hepatic encephalopathy
Intractable ascites not controllable by medical therapy
History of variceal bleeding within last 3 months; serum total bilirubin level ≥ 50 umol/L
Serum albumin level < 25g/L
International normalized ratio(INR) > 1.5
Extrahepatic metastasis
Infiltrative or diffuse tumor
Tumor number > 5
Thrombosis of target hepatic artery
Partial or complete thrombosis of the main portal vein; tumor invasion of portal branch of contralateral lobe
Hepatic vein tumor thrombus
Significant arterio-portal venous shunt
Significant arterial-hepatic venous shunt

Arm && Interventions

Group	Intervention	Description
Transarterial Ethanol Ablation (TEA)	TEA	Two treatment sessions at 2 months apart were given and started within 4 weeks after randomization.

Primary Outcome Measures

Name	Time	Method
overall survival and treatment-related toxicity	Overall survival is studied from treatment to death from any cause, for an estimated period of up to 60 months. Treatment-related toxicity is studied up to 3 months after treatment	Overall survival was defined as date of treatment to date of death from any cause. Patients alive at the end of follow-up were censored. Clinical and laboratory data were documented prospectively at baseline, during hospitalization, and at 7, 14, and 30 day, and 3, 6, 9, and 12 months. Laboratory findings were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events Version 3.

Secondary Outcome Measures

Name	Time	Method
Time to progression(TTP)	Time to progression is studied from treatment to disease progression, for an estimated period of up to 60 months.	TTP was defined as date of treatment to date of first CT evidence of disease progression. Patient death during follow-up without CT progression was censored.
Progression free survival(PFS)	Progression free survival is studied from treatment to disease progression or death from any cause, for an estimated period of up to 60 months.	PFS was defined as date of treatment to date of either first CT evidence of disease progression or death from any cause. Patients alive and free of progression at the end of follow-up were censored.
Tumor response	Tumor response is studied at 6 months after treatment	Treatment response of individual treated tumor lesions was evaluated with CT and classified according to a system combining the recommendation of European Association for the Study of the Liver and the guidelines of World Health Organization, which was considered a preferred method of response assessment following transarterial or locoregional therapies for HCC. Tumor response was classified into 4 categories: 1) complete response (CR), 2) partial response (PR), 3) static disease (SD), or 4) intralesional progression.

Locations (3): Department of Clinicl Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong
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Hong Kong, Hong Kong
Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinsese University of Hong Kong
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Hong Kong, Hong Kong
Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong
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Hong Kong, Hong Kong