Transarterial Chemotherapy (TAC) Versus Oral Chemotherapy in the Treatment of Unresectable Hepatocellular Carcinoma with Portal Vein Thrombosis: A Randomized Controlled Trial

Abstract

Background and Aim: Majority of the HCC patients report to the hospital in an advanced stage when no curative therapies can be offered. Vascular involvement (main portal vein thrombosis) limits their therapeutic options. Palliative treatment in the form of chemotherapy becomes the main stay of treatment in such advanced cases. Transarterial chemotherapy (TAC) has been tried by few researchers. Currently, radioembolization is recommended for such patients. However, it is costly and has limited availability. Whether TAC is better than oral chemotherapy (OC), this information needs exploration. This study was undertaken to ascertain the efficacy of TAC in comparison to OC in advanced HCC. Methods: Consecutive patients of unresectable HCC reporting to liver clinic AIIMS, were studied. Patients above 12 years of age, performance status 0–2, Child's A/B cirrhosis, main portal vein thrombosis and willing to enroll after informed written consent were included. Randomization into group-1 (TAC) and group-2 (OC) was done. For TAC, patients were admitted a day prior and intra-arterial chemotherapy was administered through the hepatic artery supplying the tumor after transfemoral picture. In OC group, Thalidomide and Capecitabine was used with blood test monitoring every fortnight. Clinical/imaging follow-up (FU) was done at one, three and six months’ interval and data recorded. Results: Of the 135 patients screened, 30 were found suitable and randomized (TAC-16, OC-14). Their clinical, biochemical parameters and symptomatology were comparable. The median FU was—TAC group 7 months (range 1–48 months) in the TAC group and 4.4 months (range 1–16 months) in the OC group. The cumulative survival rate at 12 months was significantly better in the TAC group compared to OC group (43.7% vs 15.4%, P—0.03). Tumor response was comparable and could be ascertained in very few patients. Conclusion: Transarterial chemotherapy is useful and provides a better survival than oral chemotherapy in advanced HCC patients.