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      Chemoembolization of hepatocellular carcinoma with cisplatin, doxorubicin, mitomycin-C, ethiodol, and polyvinyl alcohol: prospective evaluation of response and survival in a U.S. population.

      Journal of vascular and interventional radiology : JVIR
      Antibiotics, Antineoplastic, administration & dosage, Antineoplastic Agents, Antineoplastic Combined Chemotherapy Protocols, Carcinoma, Hepatocellular, pathology, surgery, therapy, Chemoembolization, Therapeutic, Cisplatin, Doxorubicin, Ethiodized Oil, Female, Follow-Up Studies, Humans, Liver Cirrhosis, complications, Liver Failure, etiology, Liver Neoplasms, Magnetic Resonance Imaging, Male, Mitomycin, Neoplasm Staging, Polyvinyl Alcohol, Prospective Studies, Remission Induction, Survival Rate, Tomography, X-Ray Computed, United States, alpha-Fetoproteins, analysis

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          To evaluate response and survival after hepatic chemoembolization with cisplatin, doxorubicin, mitomycin-C, Ethiodol, and polyvinyl alcohol in a U.S. population of patients with hepatocellular carcinoma. Thirty-eight consecutive patients were treated: 35% stage I, 62% stage II, 3% stage III. Fifty-one percent had cirrhosis. Chemoembolization was performed at approximately monthly intervals for one to seven sessions (mean, 2.2). Pretreatment and posttreatment cross-sectional imaging and alpha-fetoprotein (AFP) levels were obtained prospectively 1 month after treatment and then every 3 months. Thirty-day response was calculated by means of the the World Health Organization/Eastern Cooperative Oncology Group criteria. One patient was lost to follow-up. In seven patients, lesions became resectable after chemoembolization. Among 13 evaluable patients with initially elevated AFP level, 70% had a partial biologic response (>50% decrease in AFP), 15% had a minor response (25-50% decrease), and the remaining 15% remained stable. Among 25 patients evaluable for morphologic response, 36% had a partial response, 32% had a minor response, and 32% remained stable. No patients had progression of disease while receiving therapy. The cumulative survival was 60% at 1 year, 41% at 2 years, and 16% at 3 years. Two patients developed progressive hepatic failure. Thirty-day mortality was 3% (one patient). These results compare favorably to published response and survival data for chemoembolization of advanced hepatocellular carcinoma from Asia and Europe.

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