Treatment of Large Hepatocellular Carcinoma using Transarterial Chemoembolisation Combined with Sorafenib

Introduction: Hepatocellular Carcinoma (HCC) is the most common primary malignant tumour of liver, accounts for 90% of all primary hepatic tumours, with second most common cause for cancer-related deaths worldwide. Majority of HCC presents in Barcelona Clinic Liver Cancer (BCLC) intermediate stage (B), for which Transarterial Chemoembolisation (TACE) is the most commonly available treatment . Even though overall prognosis of these locally advanced tumours is poor, significant improvement can still be made in overall survival and recurrence free survival with locoregional therapy like TACE. Aim: To assess the efficiency, safety and limitations of TACE in large HCC with specific focus on importance of appropriate patient selection. Materials and Methods: The study was conducted on 30 histopathologically proven cases of HCC with BCLC intermediate stage. All cases underwent TACE followed by repeat TACE or treated with sorafenib depending on their response and clinical status. Treatment-related complications, treatment response, recurrence free survival was assessed. Results: Of the 30 cases, six cases had lesion size less than 5 cm, six cases with lesion size 5-10 cm and remaining 18 cases had lesion size more than 10 cm, with the largest lesion being 16 cm. Twenty-one cases had elevated Alfa Fetoprotein (AFP), chronic liver disease was seen in 10 cases, with five cases having at least two lesions. Total 50% of cases with lesion less than 5 cm showed complete response at 15 months, four of six cases with lesion size of 5-10 cm showed partial response at 15 months, other two cases were lost for follow-up. Cases with lesion size more than 10 cm showed mixed response, at 15 months follow-up, 10 cases showed stable response, six cases showed progressive disease and two patients died due to liver dysfunction. Conclusion: Transarterial Chemoembolisation combined with sorafenib prolonged the overall survival in selected large tumours with high disease burden status.