Original Article
A Comparison of Lipiodol Chemoembolization and Conservative Treatment for Unresectable Hepatocellular Carcinoma
N Engl J Med 1995; 332:1256-1261May 11, 1995
- Abstract
Background
Chemoembolization with Lipiodol (iodized oil) is widely used to treat patients with unresectable hepatocellular carcinoma. Severe side effects have been reported, and improved survival has not been clearly demonstrated.
Methods
Patients with unresectable hepatocellular carcinoma who did not have severe liver disease and who met additional entry criteria were randomly assigned to receive either Lipiodol chemoembolization (70 mg of cisplatin, 10 ml of Lipiodol, and gelatin-sponge [Gelfoam] particles delivered through the hepatic artery) or conservative management involving treatment of complications and pain. Courses of treatment were to be given every two months for a maximum of four courses. The main end point was survival.
Results
The study was stopped in December 1992, after a sequential analysis showed the lack of the expected benefit from chemoembolization. As of October 1, 1994, 39 of the 50 patients assigned to chemoembolization and 40 of the 46 patients assigned to conservative management had died. Twenty-six patients assigned to chemoembolization received all four courses of treatment. There was no significant difference in survival between the two groups, although there was a trend favoring the chemoembolization group (estimated relative risk of death in the control group, 1.4; 95 percent confidence interval, 0.9 to 2.2; P = 0.13). The comparison of survival between the two groups was not substantially changed by adjustments for differences in base-line and prognostic characteristics (adjusted relative risk, 1.3; 95 percent confidence interval, 0.8 to 2.1; P = 0.31). At one year, the estimated survival rates were 62 percent in the chemoembolization group (95 percent confidence interval, 48.6 to 75.4 percent) and 43.5 percent in the conservative-management group (95 percent confidence interval, 29.2 to 57.8 percent). In the chemoembolization group, tumor growth, as assessed by tumor size and serum alpha-fetoprotein concentration, was reduced and the incidence of portal obstruction was lower than in the conservative-management group. Liver failure occurred after 47 courses of treatment in 30 patients assigned to chemoembolization.
Conclusions
In a group of patients with unresectable hepatocellular carcinoma but without severe liver disease, Lipiodol chemoembolization reduced tumor growth, often caused acute liver failure, and did not significantly improve survival.
Media in This Article
Figure 1
Design of the Triangular Test and the Results of the Fifth Sequential Analysis.Figure 2
Kaplan–Meier Estimates of Survival in 50 Patients Assigned to Lipiodol Chemoembolization and 46 Patients Assigned to Conservative Management (P = 0.13 by the Log-Rank Test).Article Activity
- Article
The efficacy of therapies for hepatocellular carcinoma is poor.1,2 Hepatocellular carcinoma is a hypervascular tumor.3 Hepatic intraarterial injection of antitumor agents, performed to increase the local concentration of drugs and reduce systemic side effects,4 and intraarterial embolization, which causes ischemic necrosis of the tumor,5 have been used as palliative treatments, either alone or in combination (chemoembolization). Mixing anticancer drugs with Lipiodol, an iodized oily agent that remains selectively in tumors for long periods,6 may enhance the antitumor effect.7,8 Treatment combining intraarterial chemotherapy with Lipiodol and embolization, or Lipiodol chemoembolization, is considered the most effective of these methods on the basis of reports of a decrease in tumor size in nonrandomized trials.9-13 Although this method is widely used, severe side effects have been reported9,14,15 and improved survival, as suggested by case–control studies, has not been clearly demonstrated.
To test the hypothesis that Lipiodol chemoembolization would result in a 75 percent rate of survival after eight months, as compared with the 50 percent rate associated with conservative management, we compared four courses of Lipiodol chemoembolization with conservative treatment in patients who had unresectable hepatocellular carcinoma but not severe liver disease.
Methods
Consecutive patients who met the entry criteria and who agreed to participate were included in this multicenter, sequential, randomized, open-label trial. The diagnosis of hepatocellular carcinoma was based on histologic or cytologic findings or on findings of cirrhosis, liver tumor, and a serum alpha-fetoprotein value exceeding 250 ng per milliliter. Patients were excluded if they had an indication for surgery, had been treated previously for hepatocellular carcinoma, had severe hepatic disease (defined as the presence of one of the following: encephalopathy, gastrointestinal hemorrhage in the past month, clinical ascites, a serum bilirubin concentration of at least 2.9 mg per deciliter [50 μmol per liter], or a serum albumin concentration below 30 g per liter), had vascular contraindications to Lipiodol chemoembolization (such as portal obstruction of at least three segmental branches), had contraindications to treatment with cisplatin, had a serum creatinine concentration of 120 μmol per liter (1.36 mg per deciliter) or higher, or had extrahepatic metastasis.
Randomization
After providing written informed consent, prospective participants underwent arteriography. If no contraindications were identified, the patients were enrolled and underwent randomization. Randomization was stratified according to center and was carried out by telephone. The patients were assigned to one of two regimens: treatment, with one course of Lipiodol chemoembolization every two months for a total of four courses, with the first course given immediately after randomization; or conservative management, with standardized pain medications (acetaminophen or morphine, given in doses appropriate for the level of pain) and treatment of complications.
Chemoembolization
All participating radiologists had prior experience with Lipiodol chemoembolization. First, the superior mesenteric artery was injected to assess portal flow. When portal flow was adequate, the hepatic artery was catheterized. The tip of the catheter was placed distal to the gastroduodenal artery or in either the left or right branches of the hepatic artery. The emulsion consisted of 70 mg of cisplatin and 10 ml of Lipiodol (Lipiodol Ultrafluide, Laboratoire Guerbet, Aulnay-sous-Bois, France) and was prepared just before injection by mixing through a three-way stopcock from one syringe to another. With fluoroscopic guidance, the radiologists injected this mixture into the arteries that fed the tumors. The injection could be slowed or discontinued if retrograde flow occurred. Embolization was subsequently performed with gelatin-sponge (Gelfoam) particles. The goal was to decrease arterial flow without causing total obstruction. Particular care was taken to avoid reflux. After embolization, angiography was performed to determine the extent of vascular occlusion and to assess blood flow in other arterial vessels. Amoxicillin–clavulanic acid (3 g per day) and metronidazole (1.5 g per day) were administered intravenously for 24 hours before the procedure and continued for eight days either intravenously or, when possible, orally.
Follow-up
Serum alpha-fetoprotein was measured and an abdominal computed tomographic scan was obtained at the beginning of the study, every two months during the first year, and thereafter every four months. All computed tomographic scans were reviewed by two radiologists who were unaware of the patient's clinical data or treatment assignment. The average diameter of the largest nodule recorded during computed tomographic scanning before the study began was noted, and changes in the size of the tumor on subsequent scans were expressed as a percentage of the initial size of the nodule. Changes in the serum alpha-fetoprotein concentration were expressed as a percentage of the base-line levels. The extent of initial segmental portal obstruction was also assessed on hepatic arteriography.
Statistical Analysis
The main end point was survival. The study was conducted as a sequential trial to minimize the number of patients needed and obtain more rapid results. A triangular test design was used.16 The accumulated data were examined after approximately every 10 deaths. At each examination, the z and V statistics were calculated. A positive z value indicated that chemoembolization was superior to conservative management, and a negative value that chemoembolization was inferior. The V statistic approximately represents the sample size. Once the sequential values of z and V were calculated, they were plotted against one another and the plotted point was compared with the stopping boundary for the trial. The study was designed to have a type I error of 5 percent with a power of 90 percent to detect an increased survival benefit for chemoembolization after eight months as compared with conservative management. Since the survival rate after conservative management was assumed to be 50 percent, to be deemed a superior treatment, chemoembolization would have to yield a rate of 75 percent. With this approach, if the plotted point lies above the upper boundary of the triangle or below the lower boundary, the trial is stopped (upper boundary: chemoembolization 50 percent more effective than conservative management; lower boundary: less than a 50 percent difference in survival between the two treatments).
Comparisons between groups were on an intention-to-treat basis. Comparisons were made with the Wilcoxon test for continuous variables, Fisher's exact test for binary variables, and the chi-square test for categorical variables. Survival curves were estimated according to the Kaplan–Meier method17 and compared with use of the log-rank test.18 To determine factors predictive of death and to adjust the treatment comparison for base-line differences between the groups and for prognostic factors, the Cox model was used.19 The selection was based on the likelihood-ratio test. All variables having a P value in the univariate analysis of 5 percent or less were included in the model. SAS (SAS Institute, Cary, N.C.) and BMDP (BMDP Statistical Software, Los Angeles) software packages were used.
Informed Consent
The study was conducted in accordance with the ethical standards set forth in the Declaration of Helsinki. Written informed consent was obtained from each patient. As required by French regulations, the protocol was approved by one ethics committee in France (Hôpital Avicenne, Bobigny, France), as well as by ethics committees in Brussels, Belgium, and Montreal.
Results
Sequential Analysis and Decision to Stop the Trial
The trial was begun on July 15, 1990. Twenty-four centers in three countries participated. Sequential analyses were performed after approximately every 10 deaths. Figure 1Figure 1
Design of the Triangular Test and the Results of the Fifth Sequential Analysis. shows the results of the fifth sequential analysis conducted on November 1, 1992. At that time, 92 patients were enrolled: 47 in the chemoembolization group and 45 in the conservative-management group. Forty-seven deaths had been reported: 20 in the chemoembolization group and 27 in the conservative-management group. Since the lower triangular boundary had been crossed (Figure 1), the trial was stopped, and we concluded that there was less than a 50 percent increase in survival after eight months with chemoembolization as compared with conservative management (P<0.05).When entry was closed on December 1, 1992, 96 patients had been enrolled. During this period, 778 patients presented with hepatocellular carcinoma at the 24 centers, but 682 (88 percent) were excluded from the trial. The main reasons for exclusion were liver failure (205 patients, 30 percent), vascular contraindications (149 patients, 22 percent), indications for surgery (115 patients, 17 percent) or percutaneous alcohol injection (11 patients, 2 percent), extrahepatic metastasis (39 patients, 6 percent), and refusal by the patient to participate (93 patients, 14 percent). Seventy patients were excluded for various other reasons. Results are presented for the 96 patients who underwent randomization — 50 assigned to chemoembolization and 46 assigned to conservative management — and include follow-up through October 1, 1994. No patient was lost to follow-up, and 79 (82 percent) died.
Base-Line Characteristics
The diagnosis of hepatocellular carcinoma was based on histologic or cytologic findings in 79 patients and on findings of cirrhosis, liver tumor, and a serum alpha-fetoprotein concentration in excess of 250 ng per milliliter in 17 patients. The two groups were well balanced with respect to the main characteristics (Table 1Table 1
Base-Line Characteristics of the 96 Patients Studied, According to Treatment Group.). Cirrhosis was present in 87 patients (91 percent), all of whom had well-compensated liver function (Child–Pugh class A). The classification of Okuda et al.20 was used to assess liver function and tumor volume; 90 percent of the patients had stage I disease (47 in the chemoembolization group and 39 in the conservative-management group), and 10 percent had stage II disease (3 in the chemoembolization group and 7 in the conservative-management group). More patients in the conservative-management group had multinodular and large tumors and segmental portal obstruction.Survival
As of October 1, 1994, 39 patients assigned to chemoembolization had died and 40 patients assigned to conservative management had died. The causes of death — mainly, liver failure, gastrointestinal hemorrhage, and spontaneous bacterial peritonitis — did not differ between the two groups. There was no significant improvement in survival in the chemoembolization group as compared with the conservative-management group (relative risk of death in the latter group, 1.4; 95 percent confidence interval, 0.9 to 2.2; P = 0.13 by the log-rank test) (Figure 2Figure 2
Kaplan–Meier Estimates of Survival in 50 Patients Assigned to Lipiodol Chemoembolization and 46 Patients Assigned to Conservative Management (P = 0.13 by the Log-Rank Test).). At eight months, the estimated survival rate was 70 percent (95 percent confidence interval, 57.3 to 82.7 percent) in the chemoembolization group and 50 percent (95 percent confidence interval, 35.6 to 64.4 percent) in the conservative-management group; at one year, the estimated survival rates were 62 percent (95 percent confidence interval, 48.6 to 75.4 percent) and 43.5 percent (95 percent confidence interval, 29.2 to 57.8 percent), respectively; and at two years they were 37.8 percent (95 percent confidence interval, 24.3 to 51.3 percent) and 26 percent (95 percent confidence interval, 13.3 to 38.7 percent), respectively. The difference in survival between the groups was also adjusted for the following base-line variables, which were either unbalanced or prognostic as assessed by the log-rank test: Karnofsky score (P = 0.004), ascites demonstrated by ultrasonography (P<0.001), serum bilirubin concentration (P<0.001), serum albumin concentration (P = 0.004), tumor type (P = 0.02), tumor mass (P<0.001), segmental portal obstruction (P<0.001), and serum alpha-fetoprotein concentration (P = 0.009). With the use of the Cox model, the adjusted estimated risk of death remained unchanged, with a relative risk of 1.3 (95 percent confidence interval, 0.8 to 2.1) in the conservative-management group as compared with the chemoembolization group (P = 0.31 by the likelihood-ratio test).Tumor Growth
Fifteen patients died within two months of randomization (seven in the chemoembolization group and eight in the conservative-management group). In the other 81 patients, tumor growth, as assessed by tumor size and the serum alpha-fetoprotein concentration, was reduced in the chemoembolization group as compared with the conservative-management group (Table 2Table 2
Maximal Changes in Tumor Size and Serum Alpha-fetoprotein Concentrations and Occurrence of Portal Obstruction in the 81 Patients Who Survived More than Two Months after Randomization.). The incidence of portal obstruction was lower in the chemoembolization group (one segmental and two truncal obstructions occurring more than eight months after enrollment in three patients) than in the conservative-management group (seven segmental and three truncal obstructions occurring less than eight months after enrollment in four patients and after more than eight months in six patients). There was no difference between groups in the occurrence of extrahepatic metastasis.Outcome and Complications of Chemoembolization
Among the 50 patients assigned to chemoembolization, 49 received at least one course of chemoembolization and 26 received all four of the planned courses. The patient who was not treated had a hepatic-artery dissection during arteriography before treatment was begun. The reasons for stopping treatment early in 23 patients were death (13 patients), arterial obstruction (5), proximal arterioportal fistula (1), extrahepatic metastasis (1), and refusal by the patient to continue (3).
In the chemoembolization group, a temperature of 38°C or above, abdominal pain, or vomiting was noted in 86 percent of the courses in 47 patients (Table 3Table 3
Complications of 148 Courses of Lipiodol Chemoembolization in the 50 Patients Assigned to Such Treatment.). These symptoms lasted a mean (±SD) of 2.5±2.1 days (range, 1 to 10). Liver failure, defined as the presence of encephalopathy, ascites, or an increase in the serum bilirubin concentration of 0.9 mg per deciliter (15 μmol per liter) or more, occurred after 47 courses of treatment in 30 patients. Gastrointestinal hemorrhage was caused by esophagitis (two patients), duodenal ulcer (one patient), and antral ulcerations (one patient). One patient with diffuse hepatocellular carcinoma and cirrhosis graded as Child–Pugh class A died of liver failure 10 days after the second course of treatment. Death was considered a complication of treatment because this patient's liver function was judged to be well compensated before treatment and acute liver failure occurred immediately after treatment. In the six other patients who were treated and who died within two months after randomization, death was not as clearly related to the treatment.Other complications of chemoembolization included dysuria, hiccups, and inguinal hematoma in two patients each and worsened diabetes, a decrease in the platelet count to below 70,000 per cubic millimeter, and a decrease in the serum sodium concentration to below 125 mmol per liter in one patient each. The average period of hospitalization was 6.6 days (range, 2 to 24) for each course of treatment. The mean (±SD) number of days of hospitalization per patient during the first eight months of the study (or until death) was significantly higher in the chemoembolization group than in the conservative-management group (29±16 days vs. 13±14 days, P<0.001 by the Wilcoxon test).
Deviations from the Protocol
Two patients assigned to conservative management each received three courses of chemoembolization. One patient requested this treatment after randomization, and the other was inadvertently treated because of a mistake in transmitting the treatment assignment. These patients were analyzed as part of the conservative-management group and survived 7 and 29 months, respectively. Analysis of the data after the exclusion of these two patients did not change the survival results. One patient assigned to chemoembolization received only one course of treatment because of arterial obstruction and thereafter received percutaneous alcohol injection.
Discussion
Using a sequential design, we did not demonstrate a survival benefit for repeated Lipiodol chemoembolization in patients with unresectable hepatocellular carcinoma but without severe liver disease. Nonetheless, there was a trend toward increased survival, with an estimated relative risk of death of 1.4 in the conservative-management group (95 percent confidence interval, 0.9 to 2.2) as compared with the chemoembolization group. Since imbalances in base-line and prognostic characteristics between the groups could have favored the chemoembolization group, adjustments were made with a Cox model. After this analysis, the relative risk of death in the conservative-management group as compared with the chemoembolization group was estimated to be 1.3 (95 percent confidence interval, 0.8 to 2.1).
Lipiodol chemoembolization has numerous side effects, requires hospitalization, and is expensive.9,14,15 Since it did not markedly improve survival, we do not believe its use can be recommended. Death was the main reason treatment was discontinued before four courses had been completed, emphasizing the frequency of treatment failure.
Consensus is lacking about the most suitable method of chemoembolization. The use of Lipiodol and Gelfoam particles is the most generally accepted method. As compared with Gelfoam particles, Gelfoam powder may cause more harm to areas of the liver without tumor, especially in patients with cirrhosis.21,22 The use of chemotherapy is also controversial. Cisplatin has been suggested to be more effective than doxorubicin,23,24 particularly in one randomized trial.8 We used a lower dose of cisplatin (70 mg) than have other studies8,25 in order to reduce the side effects of the medication, especially renal toxicity. Our prior experience suggested that patients with alcoholic cirrhosis are highly susceptible to the toxic effects of cisplatin.
In our study, tumor size decreased in more than half the patients who received chemoembolization and was stable in most other patients in this group. This finding is consistent with those of previous nonrandomized studies.9,12,25-27 In contrast, tumor size increased in half the patients assigned to conservative management. The pattern of findings for the serum alpha-fetoprotein concentration was similar. The incidence of portal obstruction was higher in the conservative-management group than the chemoembolization group.
Case–control studies have reported that chemoembolization may markedly increase survival in hepatocellular carcinoma.9,10,12,13,28 The type of controls selected in these studies, however, is open to question. The beneficial effect suggested in one study could be related to the very low survival rate in the control group (0 percent at one year, in contrast with 43 percent in our study).12 In a randomized trial comparing chemoembolization and conservative management, survival was not significantly improved in the group treated with doxorubicin and Gelfoam powder.29
We found that Lipiodol chemoembolization significantly inhibited tumor growth. This benefit may have been offset by worsened liver function, particularly in patients with cirrhosis. Prognostic factors for survival were related to growth of the tumor, as well as to signs of severe chronic liver disease, such as abnormal serum bilirubin and serum albumin concentrations, as previously shown.30-32 Liver failure is a frequent cause of death in patients with cirrhosis and hepatocellular carcinoma.20,33-35 Despite the exclusion of patients with overt liver failure, three fifths of the patients had at least one episode of liver decompensation within a few days of treatment, and one patient died. It is possible that Lipiodol chemoembolization may be beneficial in a more select group of patients, but factors predictive of a response to this treatment, without the development of side effects, have yet to be determined.36,37
Supported by grants from Assistance Publique–Hôpitaux de Paris (87/1990), Société Nationale Française de Gastroentérologie, and Caisses d'Epargne d'Ile-de-France.
We are indebted to Professor Daniel Dhumeaux for help in initiating the study and to Professor Alain Roche for technical advice.
Source Information
Address reprint requests to Dr. Jean-Claude Trinchet at the Service d'Hépato-gastroentérologie, Hôpital Jean Verdier, Ave. du 14 juillet, 93143 Bondy CEDEX, France.
The members of the Groupe d'Etude et de Traitement du Carcinome Hépatocellulaire are listed in the Appendix. This article was prepared by Jean-Claude Trinchet, M.D., Ph.D., Antoine Abou Rached, M.D., and Michel Beaugrand, M.D., Hôpital Jean Verdier, Bondy, France; Didier Mathieu, M.D., Hôpital Henri Mondor, Créteil, France; and Sylvie Chevret, M.D., Ph.D., and Claude Chastang, M.D., Ph.D., Hôpital Saint Louis, Paris. Dr. Trinchet, as principal investigator, assumes full responsibility for the overall content and integrity of the manuscript.
Appendix
The following investigators participated in the Groupe d'Etude et de Traitement du Carcinome Hépatocellulaire:Centre Hospitalier Universitaire, Angers, France — F. Oberti, O. Ruget, P. Calès, and C. Caron-Poitreau; Hôpital Jean Verdier, Bondy, France — J.C. Trinchet, A. Abou Rached, Y. Ajavon, and M. Beaugrand; Hôpital du Haut Lévêque, Pessac, France — F. Dumas, P. Couzigou, and J. Drouillard; Hôpital Saint André, Bordeaux, France — C. Balabaud and P. Grelet; Hôpital Saint Luc et Cliniques Universitaires de Mont-Godinne, Brussels, Belgium — A. Guebel, M. Mélange, J. Pringot, and B. Van Beers; Hôpital Beaujon, Clichy, France — A. Hadengue, V. Vilgrain, and S. Erlinger; Hôpital Henri Mondor, Créteil, France — C. Duvoux, D. Mathieu, and D. Dhumeaux; Hôpital Albert Michallon, Grenoble, France — J.P. Zarski and S. Dalsoglio; Hôpital Edouard Herriot, Lyons, France — F. Mion, P.J. Valette, and P. Paliard; Centre Hospitalier Lyon Sud, Pierre Bénite, France — S. Claudel-Bonvoisin, J.C. Emery, and L. Descos; Hôpital Saint-Luc, Montreal — M. Dagenais, M.P. Dufresne, R. Lapointe, and P.M. Huet; Centre Hospitalier Universitaire, Vandoeuvre-les-Nancy, France — V. Bas, D. Regent, C. Bazin, and M.A. Bigard; Hôpital Guillaume et Renée Laënnec, Nantes, France — B. Humeau, A. Bury, M. Le Rhun, F. Lerat, H. Gibaud, R. Rymer, and L. Le Bodic; Hôtel Dieu, Nantes, France —C. Masliah, B. Pouliquen, and D. Perrin; Hôpital Saint Louis, Paris — C. Chastang; Hôpital Saint Antoine, Paris — O. Chazouillères, A. Loria, R. Poupon, A. Pauwels, N. Mostefa-Kara, V.G. Lévy, P. Balladur, J.P. Deutsch, and J.M. Tubiana; Hôpital Necker, Paris — S. Pol and P. Berthelot; Hôpital de la Salpêtrière, Paris — D. Valla, J.C. Bousquet, and P. Opolon; Centre Hospitalier, Pontoise, France — M. Bouvry; Centre Hospitalier Delafontaine, Saint Denis, France — H. Labadie; Centre Hospitalier Général, Saint-Nazaire, France — T. Martin; Centre Hospitalier Universitaire, Strasbourg, France — J.P. Bronowicki and D. Vetter; Clinique de l'Orangerie, Strasbourg, France — J.J. Wenger; and Centre Hospitalier Universitaire, Toulouse, France — L. Buscail, J. Frexinos, and F. Joffre.
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- Citing Articles (287)
Citing Articles
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Hidenori Toyoda, Takashi Kumada, Toshifumi Tada, Yasuhiro Sone, Masashi Fujimori. (2012) Transarterial Chemoembolization for Hepatitis B Virus–Associated Hepatocellular Carcinoma: Improved Survival after Concomitant Treatment with Nucleoside Analogues. Journal of Vascular and Interventional Radiology
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Carlos Rodríguez de Lope, Silvia Tremosini, Alejandro Forner, María Reig, Jordi Bruix. (2012) Management of HCC. Journal of Hepatology 56, S75-S87
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Gisèle N'Kontchou, Olivier Seror, Michel Beaugrand. 2011. Who could Benefit from Chemoembolisation?. , 125-135.
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Chengbing Jin, Hui Zhu, Zhibiao Wang, Feng Wu, Wenzhi Chen, Kequan Li, Haibing Su, Kun Zhou, Wenting Gong. (2011) High-intensity focused ultrasound combined with transarterial chemoembolization for unresectable hepatocellular carcinoma: Long-term follow-up and clinical analysis. European Journal of Radiology 80:3, 662-669
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Peter Huppert. (2011) Current concepts in transarterial chemoembolization of hepatocellular carcinoma. Abdominal Imaging 36:6, 677-683
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Riccardo Lencioni. (2011) Management of hepatocellular carcinoma with transarterial chemoembolization in the era of systemic targeted therapy. Critical Reviews in Oncology/Hematology
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Mathieu Boulin, Anne Ciboulet, Boris Guiu, Emilie Maillard, Franck Bonnetain, Anne Minello, Alice Gagnaire, Côme Lepage, Denis Krause, Patrick Hillon, Laurent Bedenne, Jean-Pierre Cercueil, Bruno Chauffert, Jean Louis Jouve. (2011) Randomised controlled trial of lipiodol transarterial chemoembolisation with or without amiodarone for unresectable hepatocellular carcinoma. Digestive and Liver Disease 43:11, 905-911
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Gerald Antoch, Grit Roelle, Susanne C. Ladd, Hilmar Kuehl, Till A. Heusner, Georgios C. Sotiropoulos, Philip Hilgard, Michael Forsting, Ruediger Verhagen. (2011) Selective and sequential transarterial chemoembolization: Survival in patients with hepatocellular carcinoma. European Journal of Radiology
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Pietro Majno, Riccardo Lencioni, Françoise Mornex, Nicolas Girard, Ronnie T. Poon, Daniel Cherqui. (2011) Is the treatment of hepatocellular carcinoma on the waiting list necessary?. Liver Transplantation 17:S2, S98-S108
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Charles E. Ray, Ziv J Haskal, Jean-Francois H. Geschwind, Brian S. Funaki. (2011) The Use of Transarterial Chemoembolization in the Treatment of Unresectable Hepatocellular Carcinoma: A Response to the Cochrane Collaboration Review of 2011. Journal of Vascular and Interventional Radiology
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Nikolaus Kohles, Dorothea Nagel, Dietrich Jüngst, Jürgen Durner, Petra Stieber, Stefan Holdenrieder. (2011) Prognostic relevance of oncological serum biomarkers in liver cancer patients undergoing transarterial chemoembolization therapy. Tumor Biology
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Ju-Bo Zhang, Yi Chen, Boheng Zhang, Xiaoying Xie, Lan Zhang, Ninling Ge, Zhenggang Ren, Sheng-Long Ye. (2011) Prognostic significance of serum gamma-glutamyl transferase in patients with intermediate hepatocellular carcinoma treated with transcatheter arterial chemoembolization. European Journal of Gastroenterology & Hepatology 23:9, 787-793
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Katerina Malagari, Mary Pomoni, Themistoklis N. Spyridopoulos, Hippokratis Moschouris, Alexis Kelekis, Spyros Dourakis, Efthymia Alexopoulou, John Koskinas, Michalis Angelopoulos, John Kornezos, Anastasia Pomoni, Savvas Tandeles, Athanasios Marinis, Spyros Rizos, Dimitrios Kelekis. (2011) Safety Profile of Sequential Transcatheter Chemoembolization with DC Bead™: Results of 237 Hepatocellular Carcinoma (HCC) Patients. CardioVascular and Interventional Radiology 34:4, 774-785
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Antoine Bouvier, Violaine Ozenne, Christophe Aubé, Jérôme Boursier, Marie Pierre Vullierme, Francine Thouveny, Olivier Farges, Valérie Vilgrain. (2011) Transarterial chemoembolisation: effect of selectivity on tolerance, tumour response and survival. European Radiology 21:8, 1719-1726
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Daisuke Yamasaki, Natsuko Kawabe, Hitomi Nakamura, Keisuke Tachibana, Kenji Ishimoto, Toshiya Tanaka, Hiroyuki Aburatani, Juro Sakai, Takao Hamakubo, Tatsuhiko Kodama, Takefumi Doi. (2011) Fenofibrate suppresses growth of the human hepatocellular carcinoma cell via PPARα-independent mechanisms. European Journal of Cell Biology 90:8, 657-664
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Oliver Dudeck, Jens Ricke. (2011) Advances in regional chemotherapy of the liver. Expert Opinion on Drug Delivery 8:8, 1057-1069
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Bruno Sangro, Riad Salem, Andrew Kennedy, Douglas Coldwell, Harpreet Wasan. (2011) Radioembolization for Hepatocellular Carcinoma. American Journal of Clinical Oncology 34:4, 422-431
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Zhengang Sun, Gaopeng Li, Xi Ai, Baoming Luo, Yanling Wen, Zizhuo Zhao, Shengli Dong, Jian Guan. (2011) Hepatic and biliary damage after transarterial chemoembolization for malignant hepatic tumors: Incidence, diagnosis, treatment, outcome and mechanism. Critical Reviews in Oncology/Hematology 79:2, 164-174
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Satoshi Takaki, Hiroshi Sakaguchi, Hiroshi Anai, Toshihiro Tanaka, Kiyosei Yamamoto, Kengo Morimoto, Hideyuki Nishiofuku, Masayoshi Inoue, Satoru Sueyoshi, Takeshi Nagata, Teruyuki Hidaka, Hideo Uchida, Kimihiko Kichikawa. (2011) Long-Term Outcome of Transcatheter Subsegmental and Segmental Arterial Chemoemobolization Using Lipiodol for Hepatocellular Carcinoma. CardioVascular and Interventional Radiology
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S. Iwasa, M. Ikeda, T. Okusaka, H. Ueno, C. Morizane, K. Nakachi, S. Mitsunaga, S. Kondo, A. Hagihara, S. Shimizu, M. Satake, Y. Arai. (2011) Transcatheter Arterial Infusion Chemotherapy with a Fine-powder Formulation of Cisplatin for Advanced Hepatocellular Carcinoma Refractory to Transcatheter Arterial Chemoembolization. Japanese Journal of Clinical Oncology 41:6, 770-775
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Jay Requarth. (2011) Image-Guided Palliative Care Procedures. Surgical Clinics of North America 91:2, 367-402
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Roberto S Oliveri, Jørn Wetterslev, Christian Gluud, Roberto S Oliveri. 2011. Transarterial (chemo)embolisation for unresectable hepatocellular carcinoma. .
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Massimo Iavarone, Massimo Colombo. (2011) HBV-related HCC, clinical issues and therapy. Digestive and Liver Disease 43, S32-S39
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Ik Jae Lee, Jinsil Seong. (2011) Radiotherapeutic Strategies in the Management of Hepatocellular Carcinoma. Oncology 81:s1, 123-133
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Philip Hilgard, Monia Hamami, Amr El Fouly, André Scherag, Stefan Müller, Judith Ertle, Till Heusner, Vito R. Cicinnati, Andreas Paul, Andreas Bockisch, Guido Gerken, Gerald Antoch. (2010) Radioembolization with yttrium-90 glass microspheres in hepatocellular carcinoma: European experience on safety and long-term survival. Hepatology 52:5, 1741-1749
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Pietro Majno, Gilles Mentha, Christian Toso, . (2010) Transplantation for hepatocellular carcinoma: Management of patients on the waiting list. Liver Transplantation 16:S2, S2-S11
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Massimo Colombo, Massimo Iavarone. 2010. Hepatocellular Carcinoma. , 650-660.
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Terence C. Chua, Francis Chu, S. Patrick Butler, Richard J. Quinn, Derek Glenn, Winston Liauw, David L. Morris. (2010) Intra-arterial iodine-131-lipiodol for unresectable hepatocellular carcinoma. Cancer 116:17, 4069-4077
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Riccardo Lencioni. (2010) Loco-regional treatment of hepatocellular carcinoma. Hepatology 52:2, 762-773
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Beatrijs A. Seinstra, Otto M. Delden, Karel J. Erpecum, Richard Hillegersberg, Willem P. Th. M. Mali, Maurice A. A. J. Bosch. (2010) Minimally invasive image-guided therapy for inoperable hepatocellular carcinoma: What is the evidence today?. Insights into Imaging 1:3, 167-181
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Fabio Piscaglia, Luigi Bolondi. (2010) The intermediate hepatocellular carcinoma stage: Should treatment be expanded?. Digestive and Liver Disease 42, S258-S263
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(2010) Chapter 5: Transcatheter arterial chemoembolization. Hepatology Research 40, 96-112
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Masamichi Moriguchi, Tadatoshi Takayama, Masahiko Nakamura, Osamu Aramaki, Tokio Higaki, Hisashi Nakayama, Takao Ohkubo, Masashi Fujii. (2010) Phase I/II study of a fine-powder formulation of cisplatin for transcatheter arterial chemoembolization in hepatocellular carcinoma. Hepatology Research 40:4, 369-375
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Giuseppe Cabibbo, Marco Enea, Massimo Attanasio, Jordi Bruix, Antonio Craxì, Calogero Cammà. (2010) A meta-analysis of survival rates of untreated patients in randomized clinical trials of hepatocellular carcinoma. Hepatology 51:4, 1274-1283
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H.-J. Yoon, J.H. Kim, K.-A. Kim, I.-S. Lee, G.-Y. Ko, H.-Y. Song, D.I. Gwon. (2010) Transcatheter arterial chemo-lipiodol infusion for unresectable hepatocellular carcinoma in 96 high-risk patients. Clinical Radiology 65:4, 271-277
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Antonio Nicolini, Laura Martinetti, Silvia Crespi, Marco Maggioni, Angelo Sangiovanni. (2010) Transarterial Chemoembolization with Epirubicin-eluting Beads versus Transarterial Embolization before Liver Transplantation for Hepatocellular Carcinoma. Journal of Vascular and Interventional Radiology 21:3, 327-332
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Shintaro Shirai, Morio Sato, Kazuhiro Suwa, Kazushi Kishi, Chigusa Shimono, Tetsuo Sonomura, Nobuyuki Kawai, Hirohiko Tanihata, Hiroki Minamiguchi, Motoki Nakai. (2010) Feasibility and Efficacy of Single Photon Emission Computed Tomography-Based Three-Dimensional Conformal Radiotherapy for Hepatocellular Carcinoma 8 cm or More With Portal Vein Tumor Thrombus in Combination With Transcatheter Arterial Chemoembolization. International Journal of Radiation Oncology*Biology*Physics 76:4, 1037-1044
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Cheng Jin, Haimin Li, Yong He, Min He, Ling Bai, Yunxin Cao, Wenjie Song, Kefeng Dou. (2010) Combination chemotherapy of doxorubicin and paclitaxel for hepatocellular carcinoma in vitro and in vivo. Journal of Cancer Research and Clinical Oncology 136:2, 267-274
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, Johannes Lammer, Katarina Malagari, Thomas Vogl, Frank Pilleul, Alban Denys, Anthony Watkinson, Michael Pitton, Geraldine Sergent, Thomas Pfammatter, Sylvain Terraz, Yves Benhamou, Yves Avajon, Thomas Gruenberger, Maria Pomoni, Herbert Langenberger, Marcus Schuchmann, Jerome Dumortier, Christian Mueller, Patrick Chevallier, Riccardo Lencioni. (2010) Prospective Randomized Study of Doxorubicin-Eluting-Bead Embolization in the Treatment of Hepatocellular Carcinoma: Results of the PRECISION V Study. CardioVascular and Interventional Radiology 33:1, 41-52
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Hee Yeon Kim, Jin Dong Kim, Si Hyun Bae, Jun Yong Park, Kwang Hyub Han, Hyun Young Woo, Jong Young Choi, Seung Kew Yoon, Byoung Kuk Jang, Jae Seok Hwang, Sang Gyune Kim, Young Seok Kim, Yeon Seok Seo, Hyung Joon Yim, Soon Ho Um, . (2010) A comparative study of high-dose hepatic arterial infusion chemotherapy and transarterial chemoembolization using doxorubicin for intractable, advanced hepatocellular carcinoma. The Korean Journal of Hepatology 16:4, 355
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Juwon Lim, Soyeun Kim, Soshin Ke, Belong Cho. (2010) The Association Chronic Liver Diseases with Health Related Behaviors in South Korea. Korean Journal of Family Medicine 31:4, 302
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Thomas J. Vogl, Nagy N.N. Naguib, Nour-Eldin A. Nour-Eldin, Pramod Rao, Alborz Hedayati Emami, Stefan Zangos, Mohamed Nabil, Ahmed Abdelkader. (2009) Review on transarterial chemoembolization in hepatocellular carcinoma: Palliative, combined, neoadjuvant, bridging, and symptomatic indications. European Journal of Radiology 72:3, 505-516
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Yang Yu, Qingbo Lang, Zhe Chen, Bai Li, Chaoqin Yu, Dezeng Zhu, Xiaofeng Zhai, Changquan Ling. (2009) The efficacy for unresectable hepatocellular carcinoma may be improved by transcatheter arterial chemoembolization in combination with a traditional Chinese herbal medicine formula. Cancer 115:22, 5132-5138
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M. MABED, M. ESMAEEL, T. EL-KHODARY, M. AWAD, T. AMER. (2009) A randomized controlled trial of transcatheter arterial chemoembolization with lipiodol, doxorubicin and cisplatin versus intravenous doxorubicin for patients with unresectable hepatocellular carcinoma. European Journal of Cancer Care 18:5, 492-499
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Stephen L Chan, Anthony TC Chan, Winnie Yeo. (2009) Role of α-fetoprotein in hepatocellular carcinoma: prognostication, treatment monitoring or both?. Future Oncology 5:6, 889-899
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Drishty Satpati, Usha Pandey, H.D. Sarma, Meera Venkatesh, Sharmila Banerjee. (2009) Preparation and Evaluation of 99m Tc(CO) 3 -Labeled Pentadecanoic Acid Derivative and Its Suspension in Lipiodol. Cancer Biotherapy & Radiopharmaceuticals 24:4, 503-507
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Giada Pietrosi, Roberto Miraglia, Angelo Luca, Giovanni Battista Vizzini, Daniela Fili', Volpes Riccardo, Adele D'Antoni, Ioannis Petridis, Luigi Maruzzelli, Domenico Biondo, Bruno Gridelli. (2009) Arterial Chemoembolization/Embolization and Early Complications after Hepatocellular Carcinoma Treatment: A Safe Standardized Protocol in Selected Patients with Child Class A and B Cirrhosis. Journal of Vascular and Interventional Radiology 20:7, 896-902
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Rubén López-Benítez, Götz M. Richter, Hans-Ulrich Kauczor, Sibylle Stampfl, Juliane Kladeck, Boris A. Radeleff, Martin Neukamm, Peter J. Hallscheidt. (2009) Analysis of Nontarget Embolization Mechanisms During Embolization and Chemoembolization Procedures. CardioVascular and Interventional Radiology 32:4, 615-622
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Daniel B. Brown, Jean-Francois H. Geschwind, Michael C. Soulen, Steven F. Millward, David Sacks. (2009) Society of Interventional Radiology Position Statement on Chemoembolization of Hepatic Malignancies. Journal of Vascular and Interventional Radiology 20:7, S317-S323
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Boris Guiu, Cédric Colin, Jean-Pierre Cercueil, Romaric Loffroy, Séverine Guiu, Emmanuelle Ferrant, Jean-Louis Jouve, Franck Bonnetain, Mathieu Boulin, François Ghiringhelli, Anne Minello, Patrick Hillon, Laurent Bedenne, Denis Krause, Bruno Chauffert. (2009) Pilot Study of Transarterial Chemoembolization With Pirarubicin and Amiodarone for Unresectable Hepatocellular Carcinoma. American Journal of Clinical Oncology 32:3, 238-244
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Kang Mo Kim, Jong Hoon Kim, Ik Soo Park, Gi-Young Ko, Hyun-Ki Yoon, Kyu-Bo Sung, Young-Suk Lim, Han Chu Lee, Young Hwa Chung, Yung Sang Lee, Dong Jin Suh. (2009) Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion. Journal of Gastroenterology and Hepatology 24:5, 806-814
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Xueying Sun, Hongchi Jiang, Xian Jiang, Hongtao Tan, Qinghui Meng, Bei Sun, Ruian Xu, Geoffrey W. Krissansen. (2009) Antisense Hypoxia-Inducible Factor-1α Augments Transcatheter Arterial Embolization in the Treatment of Hepatocellular Carcinomas in Rats. Human Gene Therapy 20:4, 314-324
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Charles E. Woodall, Charles R. Scoggins, Susan F. Ellis, Clifton M. Tatum, Michael J. Hahl, Kadiyala V. Ravindra, Kelly M. McMasters, Robert C.G. Martin. (2009) Is Selective Internal Radioembolization Safe and Effective for Patients with Inoperable Hepatocellular Carcinoma and Venous Thrombosis?. Journal of the American College of Surgeons 208:3, 375-382
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Susana Oquiñena, Francisco Guillen-Grima, Mercedes Iñarrairaegui, Jose M. Zozaya, Bruno Sangro. (2009) Spontaneous regression of hepatocellular carcinoma: a systematic review. European Journal of Gastroenterology & Hepatology 21:3, 254-257
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Yu-Jie Huang, Hsuan-Chih Hsu, Chang-Yu Wang, Chong-Jong Wang, Hui-Chun Chen, Eng-Yen Huang, Fu-Min Fang, Sheng-Nan Lu. (2009) The Treatment Responses in Cases of Radiation Therapy to Portal Vein Thrombosis in Advanced Hepatocellular Carcinoma. International Journal of Radiation Oncology*Biology*Physics 73:4, 1155-1163
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Feng Yinglu, Ling Changquan, Zhai Xiaofeng, Li Bai, Zhu Dezeng, Chen Zhe. (2009) A New Way: Alleviating Postembolization Syndrome Following Transcatheter Arterial Chemoembolization. The Journal of Alternative and Complementary Medicine 15:2, 175-181
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Hee Sun Park, Jeong-Min Lee, Se Hyung Kim, Samuel Chang, Soo Jin Kim, Joon Koo Han, Byung Ihn Choi. (2009) Differentiation of well-differentiated hepatocellular carcinomas from other hepatocellular nodules in cirrhotic liver: Value of SPIO-enhanced MR imaging at 3.0 Tesla. Journal of Magnetic Resonance Imaging 29:2, 328-335
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Ju Hyun Shim, Joong-Won Park, Joon-Il Choi, Hyun-Beom Kim, Woo Jin Lee, Chang-Min Kim. (2009) Does Postembolization Fever after Chemoembolization Have Prognostic Significance for Survival in Patients with Unresectable Hepatocellular Carcinoma?. Journal of Vascular and Interventional Radiology 20:2, 209-216
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Jason W. Mitchell, William G. O'Connell, Piotr Kisza, David P. Klyde, Sharon F. Gonzalez, Pierre Maldjian, Philip Bahramipour, Sohail G. Contractor. (2009) Safety and Feasibility of Outpatient Transcatheter Hepatic Arterial Embolization for Hepatocellular Carcinoma. Journal of Vascular and Interventional Radiology 20:2, 203-208
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Sung Wook Shin. (2009) The Current Practice of Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma. Korean Journal of Radiology 10:5, 425
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Eishiro Mizukoshi, Yasunari Nakamoto, Kuniaki Arai, Tatsuya Yamashita, Naofumi Mukaida, Kouji Matsushima, Osamu Matsui, Shuichi Kaneko. (2009) Enhancement of tumor-specific T-cell responses by transcatheter arterial embolization with dendritic cell infusion for hepatocellular carcinoma. International Journal of CancerNA-NA
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Min Jae Yang, So Yun An, Eun Joon Moon, Min Suk Lee, Joo An Hwang, Jae Youn Cheong, Je Hwan Won, Jai Keun Kim, Hee Jung Wang, Sung Won Cho. (2009) Comparison of radiofrequency ablation and transarterial chemoembolization for the treatment of a single hepatocellular carcinoma smaller than 4 cm. The Korean Journal of Hepatology 15:4, 474
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Jia-ping Li, Jian-ping Chu, Jian-yong Yang, Wei Chen, Yu Wang, Yong-hui Huang. (2008) Preoperative Transcatheter Selective Arterial Chemoembolization in Treatment of Unresectable Hepatoblastoma in Infants and Children. CardioVascular and Interventional Radiology 31:6, 1117-1123
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Bruno M Strebel, Jean-François Dufour. (2008) Combined approach to hepatocellular carcinoma: a new treatment concept for nonresectable disease. Expert Review of Anticancer Therapy 8:11, 1743-1749
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Wei Lu, Yan-Hao Li, Xiao-Feng He, Jian-Bo Zhao, Yong Chen, Que-Lin Mei. (2008) Necrosis and Apoptosis in Hepatocellular Carcinoma Following Low-Dose Versus High-Dose Preoperative Chemoembolization. CardioVascular and Interventional Radiology 31:6, 1133-1140
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Patricia Roxburgh, T. R. Jeffry Evans. (2008) Systemic therapy of hepatocellular carcinoma: Are we making progress?. Advances in Therapy 25:11, 1089-1104
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Katerina Malagari. (2008) Drug-eluting particles in the treatment of HCC: chemoembolization with doxorubicin-loaded DC Bead™. Expert Review of Anticancer Therapy 8:10, 1643-1650
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Stéphanie Becker, Sophie Laffont, Fabien Vitry, Yan Rolland, Joseph Lecloirec, Eveline Boucher, Jean-Luc Raoul, Jean-Yves Herry, Patrick Bourguet, Etienne Garin. (2008) Dosimetric evaluation and therapeutic response to internal radiation therapy of hepatocarcinomas using iodine-131-labelled lipiodol. Nuclear Medicine Communications 29:9, 815-825
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Katerina Malagari, Efthimia Alexopoulou, Katerina Chatzimichail, Brenda Hall, John Koskinas, Samantha Ryan, Eva Gallardo, Alexis Kelekis, Athanassios Gouliamos, Dimitrios Kelekis. (2008) Transcatheter chemoembolization in the treatment of HCC in patients not eligible for curative treatments: midterm results of doxorubicin-loaded DC bead. Abdominal Imaging 33:5, 512-519
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Mituo Satake, Hideo Uchida, Yasuaki Arai, Hiroshi Anai, Hirosi Sakaguchi, Takashi Nagata, Tomohiko Yamane, Kimihiko Kichikawa, Yukio Osaki, Masatoshi Okazaki, Hideyuki Higashihara, Hironobu Nakamura, Keigo Osuga, Norio Nakao, Shouzou Hirota. (2008) Transcatheter Arterial Chemoembolization (TACE) with Lipiodol to Treat Hepatocellular Carcinoma: Survey Results from the TACE Study Group of Japan. CardioVascular and Interventional Radiology 31:4, 756-761
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Zhen Fan Yang, Ronnie T.P. Poon. (2008) Vascular Changes in Hepatocellular Carcinoma. The Anatomical Record: Advances in Integrative Anatomy and Evolutionary Biology 291:6, 721-734
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Mary A. Maluccio, Anne M. Covey, Leah Ben Porat, Joanna Schubert, Lynn A. Brody, Constantinos T. Sofocleous, George I. Getrajdman, William Jarnagin, Ronald DeMatteo, Leslie H. Blumgart, Yuman Fong, Karen T. Brown. (2008) Transcatheter Arterial Embolization with Only Particles for the Treatment of Unresectable Hepatocellular Carcinoma. Journal of Vascular and Interventional Radiology 19:6, 862-869
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Eddie K. Abdalla, Alban Denys, Kiyoshi Hasegawa, Thomas W. T. Leung, Masatoshi Makuuchi, Ravi Murthy, Dario Ribero, Daria Zorzi, Jean-Nicolas Vauthey, Guido Torzilli. (2008) Treatment of Large and Advanced Hepatocellular Carcinoma. Annals of Surgical Oncology 15:4, 979-985
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Kazuhiro Nouso, Hironori Tanaka, Shuji Uematsu, Kunihiro Shiraga, Ryoichi Okamoto, Hideki Onishi, Shin-ichiro Nakamura, Yoshiyuki Kobayashi, Yasuyuki Araki, Noriaki Aoki, Yasushi Shiratori. (2008) Cost-effectiveness of the surveillance program of hepatocellular carcinoma depends on the medical circumstances. Journal of Gastroenterology and Hepatology 23:3, 437-444
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Peter Gunvén. (2008) Liver embolizations in oncology: A review. Medical Oncology 25:1, 1-11
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Katerina Malagari, Katerina Chatzimichael, Efthymia Alexopoulou, Alexios Kelekis, Brenda Hall, Spyridon Dourakis, Spyridon Delis, Athanasios Gouliamos, Dimitrios Kelekis. (2008) Transarterial Chemoembolization of Unresectable Hepatocellular Carcinoma with Drug Eluting Beads: Results of an Open-Label Study of 62 Patients. CardioVascular and Interventional Radiology 31:2, 269-280
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Zhen Fan Yang, Patricia Ngai, David W. Ho, Wan Ching Yu, Michael N.P. Ng, Chi Keung Lau, Mandy L. Y. Li, Ka Ho Tam, Chi Tat Lam, Ronnie T. P. Poon, Sheung Tat Fan. (2008) Identification of local and circulating cancer stem cells in human liver cancer. Hepatology 47:3, 919-928
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M. Doffoël, F. Bonnetain, O. Bouché, D. Vetter, A. Abergel, S. Fratté, J.D. Grangé, N. Stremsdoerfer, A. Blanchi, J.P. Bronowicki, F.X. Caroli-Bosc, X. Causse, F. Masskouri, P. Rougier, L. Bedenne. (2008) Multicentre randomised phase III trial comparing Tamoxifen alone or with Transarterial Lipiodol Chemoembolisation for unresectable hepatocellular carcinoma in cirrhotic patients (Fédération Francophone de Cancérologie Digestive 9402). European Journal of Cancer 44:4, 528-538
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Zhen Fan Yang, David W. Ho, Michael N. Ng, Chi Keung Lau, Wan Ching Yu, Patricia Ngai, Patrick W.K. Chu, Chi Tat Lam, Ronnie T.P. Poon, Sheung Tat Fan. (2008) Significance of CD90+ Cancer Stem Cells in Human Liver Cancer. Cancer Cell 13:2, 153-166
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Laura M. Kulik, Brian I. Carr, Mary F. Mulcahy, Robert J. Lewandowski, Bassel Atassi, Robert K. Ryu, Kent T. Sato, Al Benson, Albert A. Nemcek, Vanessa L. Gates, Michael Abecassis, Reed A. Omary, Riad Salem. (2008) Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 47:1, 71-81
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Suk Kyeong Ji, Yun Ku Cho, Yong Sik Ahn, Mi Young Kim, Yoon Ok Park, Jae Kyun Kim, Wan Tae Kim. (2008) Multivariate Analysis of the Predictors of Survival for Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Focusing on uperselective Chemoembolization. Korean Journal of Radiology 9:6, 534
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Simon C.H. Yu, Edwin P. Hui, John Wong, Herman Wong, Frankie Mo, Simon S.M. Ho, Yuen Y. Wong, Winnie Yeo, Paul B.S. Lai, Anthony T.C. Chan, Tony S.K. Mok. (2008) Transarterial Ethanol Ablation of Hepatocellular Carcinoma with Lipiodol–Ethanol Mixture: Phase II Study. Journal of Vascular and Interventional Radiology 19:1, 95-103
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A. Lubienski, M. Simon, K. Lubienski, J. Gellissen, R.-T. Hoffmann, T.F. Jakobs, T. Helmberger. (2007) Update Chemoperfusion und -embolisation. Der Radiologe 47:12, 1097-1108
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Pietro Majno, Emiliano Giostra, Gilles Mentha. (2007) Management of hepatocellular carcinoma on the waiting list before liver transplantation: Time for controlled trials?. Liver Transplantation 13:S2, S27-S35
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Laura M. Kulik, Mary F. Mulcahy, Reed A. Omary, Riad Salem. (2007) Emerging Approaches in Hepatocellular Carcinoma. Journal of Clinical Gastroenterology 41:9, 839-854
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Ronnie T.P. Poon, Wai Kuen Tso, Roberta W.C. Pang, Kelvin K.C. Ng, Regina Woo, Kin Shing Tai, Sheung Tat Fan. (2007) A Phase I/II Trial of Chemoembolization for Hepatocellular Carcinoma Using a Novel Intra-Arterial Drug-Eluting Bead. Clinical Gastroenterology and Hepatology 5:9, 1100-1108
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Alejandro Forner, M Isabel Real, Maria Varela, Jordi Bruix. (2007) Transarterial chemoembolization for patients with hepatocellular carcinoma. Hepatology Research 37:s2 Fourth JSH S, S230-S237
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L. Gellert, B. Jalaludin, M. Levy. (2007) Hepatocellular carcinoma in Sydney South West: late symptomatic presentation and poor outcome for most. Internal Medicine Journal 37:8, 516-522
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H. SHEN, D. AGARWAL, R. QI, N. CHALASANI, S. LIANGPUNSAKUL, L. LUMENG, H. YOO, P. KWO. (2007) Predictors of outcome in patients with unresectable hepatocellular carcinoma receiving transcatheter arterial chemoembolization. Alimentary Pharmacology & Therapeutics 26:3, 393-400
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M. Schwartz, S. Roayaie, P. Uva. (2007) Treatment of HCC in Patients Awaiting Liver Transplantation. American Journal of Transplantation 7:8, 1875-1881
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