الفهرس 
INTRODUCTION.Only 14 pages are availabe for public view
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Abstract
The aim of this work was to evaluate the effectiveness and safety of
trans-arterial chemoembolization with and without gel foam for the
management of HCC.
This study was conducted on 40 cirrhotic patients with primary HCC
. All patients had HCV infection.
The patients were classified into 2 groups; Group I, ٢٠ patients
treated with transcatheter arterial chemoembolization (TACE) by lipidol
and adriamycin. Group II, 20 patients were treated with TACE by lipidol
and adriamycin followed by gel foam.
The patients of each group were classified according to Child-Pough
classification to Child A, B & C.
All patients included in the study were subjected to pre treatment
evaluation in the form of detailed clinical history, thorough clinical
assessment, complete blood pictre, liver profile, AFP, kidney function
tests, upper endoscopy, colonoscopy, chest X-ray, abdominal
ultrasonography and doppler study of the portal vein, abdominal triphasic
spiral CT, bone scan, selective hepatic angiography, celiac arteriography
and digital subtraction angiography.
After proper assessment of the two groups, all patients underwent 1-3
sessions of TACE, 1-2 months apart & evaluated after sessions by CT
after 2 weeks to determine the response to treatment. TACE was then
repeated according to the response.
This program of follow up continued for six months after TACE
intervention to evaluate the effect of TACE on liver functions and alfafetoprotein
as well as, the response rate of tumor necrosis, size and newly
formed tumors and evaluate the survival rate between the studied groups .
Results of the current study showed that, the post-embolization
syndrome (fever, vomiting and/or right hypochondrial pain) was
experiences in 40% of patients in group I and in 65% of patients in group
II (P<0.001) following chemoembolization for 3-5 days. However, no
major life-threatening treatment related complications were encountered
in any of the patients.
Regarding liver function tests, there was initial worsening in both
groups 2 weeks after treatment as there was significant elevation of AST
and ALT in both groups plus significant elevation of bilirubin in group II
only. No significant change was noted regarding albumin and
prothrombin concentration.
Analysis of AFP values before and after treatment in the studied
groups showed that, there was a highly significant reduction of its levels
during the follow up period being maximal at the end of 6 months.
Mean ultrasonographic measurement of the longest diameter of the
focal lesions was 5.25 ± 1.06 cm in group I and 5.40 ± 1.0 in group II
(P>0.05) before TACE treatment. Six months after treatment, there was a
highly significant reduction in tumor size in both groups, where mean
longest diameter was 2.20 ± 1.16 cm in group I (percent reduction =
58.1%) and 1.89 ± 0.93 cm in group II (percent reduction = 63.2%)
(P<0.001) with no significant difference when comparing between group
I and group II.
Regarding CT scan, the mean baseline longest diameter of the
focal lesion in group I was 5.43±1.06 cm and in group II was
5.50±0.85cm. Six months after treatment, there was a highly significant
reduction in tumor size where the mean longest diameter was2.00±1.20 in
group I (percent reduction = 65%) and1.50±0.85 cm in group II (percent
reduction = 72.7%) (P<0.001). There was no significant difference
between both groups.
Results showed that, 45.5% of lesions in group I showed complete
response to treatment, 37.5% showed partial response and 17% showed
stationary response. In group II, 56.5% of lesions showed complete
response, 30.5% showed partial response and 13% showed stationary
response with no significant difference between the two studied groups.
Regarding overall survival, out of the studied 40 patients, 9 died
during the 6 months course of follow up with a survival rate of 77.5%. In
group 1, the 6-months survival rate was 75%, while, in group 2 it was
80% with no significant difference between both studied groups (P>0.05).
In conclusion, we found a trend toward greater survival when
gelfoam was used as the embolic agent for TACE for HCC although not
reaching significant level when compared with lipiodol.