Braun, Melsungen, Germany) and ethiodized oil (Lipiodol Ultrafluide; Guerbet, Villepinte, France) as an embolic agent. Secondly in case of TACE a mixture of doxorubicin and ethiodized oil (Lipiodol www.selleckchem.com/products/MDV3100.html Ultrafluide; Guerbet, Villepinte, France) as an embolic agent was used. TAE/TACE was performed superselectively by occluding only the tumor-feeding segmental arteries or selectively by occluding the right or left hepatic artery. In general, a superselective embolization was aimed. However, in patients with a large tumour mass or more than one nodule in the same lobe, selective embolization of the entire lobe was performed. In patients with tumor disease in both the right and the left liver lobe, only one lobe was embolized during one treatment session to avoid a prolonged postembolization syndrome or postinterventional liver failure.

A completion arteriogram was obtained to confirm occlusion of the embolized vessels. After TAE/TACE, the patients were carefully observed and side-effects of embolization were treated symptomatically. Follow-up was done with contrast-enhanced CT of the liver to assess the effect of embolization on the tumor. Depending on success of the already performed interventions embolization sessions were repeated in intervals from 1 to 3 months. Multimodal therapy Multimodal therapy (n = 17) included a combination of local ablative therapies such as percutaneous ethanol instillation (PEI), radiofrequency ablation therapy or cryotherapy on the one hand and transarterial embolization therapy as described above on the other hand.

Usually percutaneous ablative therapies were given first, after signs of tumour progression were seen treatment was continued with TAE/TACE. Palliative care 39 patients received only symptomatic therapy but no active treatment for hepatocellular carcinoma. Patients in this group rejected the offered local ablative therapies, embolization therapy or systemic treatment but opted for palliative care only. Statistical analysis Chi2 test was used to compare proportions and Mann Whitney U tests to compare median values between groups. Survival times were estimated using the Kaplan-Meier method and the differences were tested with the log-rank test. Analysis was performed with Statistica (StatSoft, Inc. (2004). STATISTICA (data analysis software system), version 6. http://www.statsoft.com).

Results Patients with BCLC stage A 40 patients were classified to BCLC stage A. Treatment modalities in this group were: long-acting octreotide [Sandostatin LAR] (n = 11 [27.5%]), TACE (n = 5 [12.5%]), multimodal therapy as defined above (n = 7 [17.5%]) and palliative care only (17 [42.5%]). Median Survival (Figure (Figure11) Figure 1 Patients with hepatocellular carcinoma and BCLC stage A. Median survival rates in long-acting octreotide [Sandostatin LAR], TACE, multimodal therapy and palliative care were 31.4, 37.3, 40.2 and 15.1 months respectively. Survival rates of patients with … Overall median survival was GSK-3 18.