Recently, it has been demonstrated that Transcatheter arterial chemoembolization (TACE) improves survival compared with best supportive care in meta-analyses of randomized trials and in two individual clinical trials.
However, although selective TACE is currently widely used, there are no reported extensive data from large series on both short and long term effects of this treatment on liver function. Equally, because the optimal number of sessions is not known, it is debatable if repeated courses of selective TACE may progressively impair liver function and if they are well tolerated or are limited by major side effects.
A research article to be published on April 21, 2009 in World Journal of Gastroenterology addresses this question. The research group, guided by Dr. Sacco from the Gastroenterology Department of Pisa University Hospital, has performed a prospective cohort study on a large group of patients affected by HCC, prospectively evaluating the short and long term impact of selective TACE on liver function. Side effects of treatments were also assessed and the overall survival and progression free survival probabilities were analyzed.
This single center study is very interesting because it evaluates, in a very large population of patients, the effective clinical impact of TACE procedure. This technique, although not included in the number of curative techniques for HCC, has proved to be efficacious in prolonging life expectancy in patients affected by primary liver cancer. Nevertheless many questions remain a matter of debate: how many times can we repeat this treatment without reducing liver function? Is there any difference between multitreated patients and subjects at the first treatment? What is the real life expectancy and HCC progression free survival probability?