Comparative Study on Transcatheter Arterial Chemoembolization, Portal Vein Embolization and High Intensity Focused Ultrasound Sequential Therapy for Patients

Objective: To investigate the safety and efficacy of transcatheter arterial chemoembolization (TACE), combinedwith portal vein embolization (PVE), and high intensity focused ultrasound (HIFU) sequential therapy in treatingpatients with hepatocellular carcinoma (HCC).
Methods: Patients with inoperative HCC were treated by twomethods: in the study group with TACE first, then PVE a week later, and then TACE+PVE every two monthsas a cycle, after 2~3 cycles finally HIFU was given; in the control group only TACE+PVE was given. Response(CR+PR), and disease control rate (CR+PR+SD), side effects, overall survival and time to progress were calculated.
Results: Main side effects of both groups were nausea and vomiting. No treatment related death occurred. In thestudy group, 32 patients received TACE for overall 67 times, PVE 64 times, and HIFU 99 times; on average 2.1,2 and 3.1 times for each patient, respectively. In the control group, 36 patients were given TACE 78 times andPVE 74 times, averaging 2.2 and 2.1 times per patient. Effective rate: 25.0% in study group and 8.3% in controlgroup (p>0.05). Disease control rates were 71.9% and 44.4%, respectively (p<0.05). In patients with portal veintumor thrombus, the rate reduced over 1/2 after treatment was 69.2%(9/13) in the study and 21.4%(3/14) in thecontrol group (p<0.05). Rate of AFP reversion or decrease over 1/2 was 66.7%(16/24) in study and 37%(10/27)(p<0.05) in control group. Median survival time: 16 months in study and 10 months in control group. PFS was7months in study and 3 months in control group. Log-rank test suggested that statistically significant differenceexists between two groups (p=0.024). 1-, 2- and 3-year survival rates were 56.3%, 18.8% and 9.3% in study, while30.6%, 5.6% and 0 in control group, respectively, with statistically significant difference between two groups (byLog-rank, p = 0.014).
Conclusions: The treatment of TACE+PVE+HIFU sequential therapy for HCC increasesresponse rate, prolong survival, and could thus be a safe and effective treatment for advanced cases.