Transarterial Chemoembolization for Hepatocellular Carcinoma: Volumetric and Morphologic CT Criteria for Assessment of Prognosis and Therapeutic Success—Results from a Liver Transplantation Center

PURPOSE: To evaluate the prognostic value of volumetric computed tomography (CT) for therapy control in patients treated with repeated transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Eighty-five patients with histologically proved HCC underwent 182 TACE procedures with 50 mg/m2 doxorubicin hydrochloride, 50 mg/m2 cisplatin, 10 mL/m2 iodized oil, and amilomer microspheres. The volumes of liver and tumor were measured with a region-of-interest CT technique. Iodized oil retention was estimated with CT performed 24–48 hours after treatment. RESULTS: Tumor volume expressed as a percentage of liver volume was less than 5% in 26, less than 15% in 33, and 15% or greater in 26 patients. The overall 1-year survival rate was 57.6% (mean, 534 days; median, 428 days). There was a statistically significant prolongation of survival when the tumor volume was less than 200 mL (P < .02) and less than 5% of the liver volume (P < .01). Complete (≥75%) and good (50%–74%) iodized oil retention raised the median survival significantly (P < .001 and P < .07, respectively). Significantly reduced survival correlated with diffuse tumor growth pattern (P < .05) and presence of more than nine lesions (P < .03). CONCLUSION: TACE resulted in significant prolongation of survival in patients with tumor volumes of less than 200 mL, tumor-to-liver volume ratios of less than 5%, and iodized oil retention greater than or equal to 75%.