Liver Resection Versus Transarterial Chemoembolization for the Treatment of Intermediate-stage Hepatocellular Carcinoma

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Sun Yat-sen University

Status and phase

Unknown
Phase 3

Conditions

Hepatocellular Carcinoma

Treatments

Drug: epirubicin , pirarubicin , hydroxycamptothecin and fluorouracil
Other: absorbable gelatin sponge particles
Procedure: liver resection
Drug: lipiodol
Procedure: transarterial chemoembolization
Drug: carboplatin

Study type

Interventional

Funder types

Other

Identifiers

NCT02755311
HCC 006

Details and patient eligibility

About

The role of transarterial chemoembolization (TACE) as the standard therapy for intermediate-stage hepatocellular carcinoma (HCC) is being challenged by increasing studies which showed that liver resection (LR) is a safe and feasible procedure with better survival outcomes than TACE does. In light of this, the investigators have constructed a Markov model to simulate comparing LR and TACE in the treatment of intermediate-stage HCC. The results suggested that LR may provide survival benefit over TACE for the treatment of intermediate-stage HCC in cirrhotic patients. However, validating the simulated result by a study with higher quality (e.g. prospective clinical trial) would be of great value in providing a more convincing finding. Therefore, based on the established Markov model, the investigators aimed to prospectively compare the treatment efficacy and safety of LR with TACE for consecutive patients with intermediate-stage HCC.

Full description

Hepatocellular carcinoma (HCC) is the 5th most common cancer worldwide and the third most frequent cause of death of cancer. However, the management strategies for intermediate-stage HCC remain controversial without global consensus. On one hand, Barcelona Clinic Liver Cancer (BCLC) staging system recommends liver resection (LR) for very early and early-stage HCC, and transarterial chemoembolization (TACE) for intermediate-stage HCC. On the other hand, observational studies in both Eastern and Western countries have emerged to suggest that LR was safe and achieved better survival than TACE for patients with intermediate-stage HCC, but only very few studies have been conducted to directly compare LR with TACE for these patients. In light of this, the investigators have conducted a multistate Markov model simulating a randomized clinical trial comparing LR with TACE over a follow-up period of 15 years. The results suggested that LR may provide survival benefit over TACE for the treatment of intermediate-stage HCC in cirrhotic patients. However, validating the simulated result by a study with higher quality (e.g. prospective clinical trial) would be of great value in providing a more convincing finding.Therefore, based on the established Markov model,the investigators aimed to prospectively compare the treatment efficacy and safety of LR with TACE for consecutive patients with intermediate-stage HCC.

Enrollment

198 estimated patients

Sex

All

Ages

18 to 75 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • age between 18 and 75 years
  • 2 to 3 lesions with at least one >3 cm in diameter; or more than 3 lesions of any diameter
  • Child-Pugh A/B liver function
  • no previous treatment
  • an Eastern Cooperative Oncology Group performance status of 0

Exclusion criteria

  • radiologic or pathological evidence of vascular invasion or extrahepatic metastases
  • severe coagulopathy (prothrombin activity <40% or a platelet count of<40,000/mm3)
  • evidence of hepatic decompensation including refractory ascites, esophageal or gastric variceal bleeding, or hepatic encephalopathy
  • obstructive jaundice
  • an American Society of Anesthesiologists score of 3 or more
  • present or past history of any other concurrent malignancies
  • complicated with other severe diseases such as chronic kidney disease, cardiovascular disease, auto-immunological disease, etc
  • contraindications to carboplatin, epirubicin, mitomycin, or lipiodol

Trial design

Primary purpose

Treatment

Allocation

Non-Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

198 participants in 2 patient groups

liver resection
Experimental group
Description:
Resection was carried out under general anesthesia using a right subcostal incision with a midline extension. Intra-operative ultrasonography was performed routinely to evaluate the tumor burden, liver remnant and the possibility of a negative resection margin. The investigators performed anatomical resection aiming at a resection margin of at least 1 cm. Pringle's maneuver was routinely used with a clamp and unclamp time of 10 minutes and 5 minutes, respectively. Hemostasis of the raw liver surface was done with suturing and application of fibrin glue.
Treatment:
Procedure: liver resection
transarterial chemoembolization
Active Comparator group
Description:
A microcatheter was inserted into the feeding arteries as selectively as possible through the lobar, segmental, or subsegmental arteries, dependent on the tumor distribution and hepatic functional reserve. Hepatic artery infusion chemotherapy was performed using 300 mg carboplatin. Subsequently, chemolipiodolization was performed mixed with 5 ml of lipiodol. According to the number and size of the lesions, and liver and kidney function of the patient, the chemotherapeutic agents, including epirubicin (50-100 mg), pirarubicin (30-50 mg), hydroxycamptothecin (10-30 mg) and fluorouracil (500-1000 mg), were determined by the multidisciplinary team. If residual flow remained after infusion of these agents, additional lipiodol was injected. Embolization was performed with absorbable gelatin sponge particles 350-560 μm in diameter.
Treatment:
Drug: carboplatin
Procedure: transarterial chemoembolization
Drug: lipiodol
Other: absorbable gelatin sponge particles
Drug: epirubicin , pirarubicin , hydroxycamptothecin and fluorouracil

Trial contacts and locations

1

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Data sourced from clinicaltrials.gov

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