Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2015; 21(36): 10443-10452
Published online Sep 28, 2015. doi: 10.3748/wjg.v21.i36.10443
Chemoembolization alone vs combined chemoembolization and hepatic arterial infusion chemotherapy in inoperable hepatocellular carcinoma patients
Song Gao, Peng-Jun Zhang, Jian-Hai Guo, Hui Chen, Hai-Feng Xu, Peng Liu, Ren-Jie Yang, Xu Zhu
Song Gao, Peng-Jun Zhang, Jian-Hai Guo, Hui Chen, Hai-Feng Xu, Peng Liu, Ren-Jie Yang, Xu Zhu, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Interventional Therapy Department, Peking University Cancer Hospital & Institute, Beijing 100142, China
Author contributions: Gao S, Yang RJ and Zhu X designed the study; Guo JH, Chen H, Xu HF and Liu P performed the research; Gao S and Zhang PJ analyzed the data; Gao S and Zhu X wrote the paper; and Zhu X revised the manuscript for final submission; Gao S and Zhang PJ contributed equally to this study; Zhu X and Yang R are the co-coressponding authors.
Supported by The Capital Health Development Special Scientific Research Projects, No. 2014-2-2154; and the Single Center Prospective Study, No. NCT01997957.
Institutional review board statement: The study was reviewed and approved by the Peking University Cancer Hospital & Institutional Review Board.
Informed consent statement: All study participants or their legal guardians provided written informed consent prior to study enrollment.
Conflict-of-interest statement: We declare that we have no financial or personal relationships with other individuals or organizations that can inappropriately influence our work and that there is no professional or other personal interest of any nature in any product, service and/or company that could be construed as influencing the position presented in or the review of the manuscript.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at drzhuxu@163.com and renjieyang2007@163.com. The study participants provided informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xu Zhu, MD, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Interventional Therapy Department, Peking University Cancer Hospital & Institute, Beijing 100142, China. drzhuxu@163.com
Telephone: +86-10-88196476 x: +86-10-88196476
Received: May 4, 2015
Peer-review started: May 5, 2015
First decision: June 3, 2015
Revised: July 13, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: September 28, 2015
Processing time: 146 Days and 23.4 Hours
Abstract

AIM: To compare the efficacy and safety of chemoembolization alone or chemoembolization combined with hepatic arterial infusion chemotherapy (HAIC), including oxaliplatin (OXA), 5-fluorouracil (5-FU) and folinic acid (CF), in inoperable hepatocellular carcinoma (HCC) without distant metastasis.

METHODS: Eighty-four inoperable HCC patients were enrolled. Thirty-nine patients underwent chemoembolization alone, and the other 45 patients underwent chemoembolization + HAIC (OXA/5-FU/CF) treatment non-randomly. The progression free survival (PFS), objective response rate (ORR), disease control rate (DCR) and adverse reactions were compared between the two groups.

RESULTS: A significant difference in the ORR was observed between the chemoembolization alone and chemoembolization + HAIC groups. There was no statistically significant difference in DCR between the two groups. The median PFS (mPFS) showed a significant difference between the two groups. For patients with BCLC stage A/B disease, with or without vessel invasion, the chemoembolization + HAIC group showed better mPFS when compared to chemoembolization alone, but no significant difference was found in patients with BCLC stage C disease. The parameter of pain (grade III-IV) in the chemoembolization + HAIC group was increased statistically.

CONCLUSION: Chemoembolization combined with HAIC with OXA/5-FU/CF may be safe and more effective than chemoembolization alone for inoperable HCC patients without distant metastasis.

Keywords: Chemoembolization; Hepatic arterial infusion chemotherapy; Oxaliplatin; Hepatocellular carcinoma

Core tip: Eighty-four inoperable hepatocellular carcinoma (HCC) patients were enrolled, 39 patients underwent chemoembolization alone, and the other 45 patients underwent chemoembolization + hepatic arterial infusion chemotherapy (HAIC) [oxaliplatin (OXA)/5-fluorouracil (5-FU)/folinic acid (CF)] treatment non-randomly. The progression free survival (PFS), objective response rate (ORR), disease control rate (DCR) and adverse reactions were compared between the two groups. A significant difference in the ORR was observed between the two groups. There was no statistically significant difference in DCR between the two groups. The median PFS (mPFS) showed a significant difference between the two groups. For patients with BCLC stage A/B disease, with or without vessel invasion, the chemoembolization + HAIC group showed better mPFS when compared to chemoembolization alone, but no significant difference was found in patients with BCLC stage C disease. The parameter of pain (grade III-IV) in the chemoembolization + HAIC group was increased statistically. Chemoembolization combined with HAIC with OXA/5-FU/CF may be safe and more effective than chemoembolization alone for inoperable HCC patients without distant metastases.