There is no standard treatment for liver cancer when surgery, transplantation, or percutaneous treatment is not possible, which applies to around three-quarters of all liver cancer cases. Arterial embolisation-the restriction of blood supply to the tumour-is widely used, but there is uncertainty whether it has a survival benefit.
Jordi Bruix and Josep Llovet from Hospital Clinic, Barcelona, Spain, lead a multicenter randomised trial among 112 cirrhotic patients with unresectable liver cancer to assess the survival benefits of arterial embolisation (use of gelatin sponge to block blood flow to the tumour) or chemoembolisation (gelatin sponge plus the chemotherapeutic drug doxorubicin) compared with conservative treatment.
The trial was stopped when it became apparent that chemoembolisation had a substantial survival benefit compared with conservative treatment. 25 of 37 patients assigned embolisation, 21 of 40 assigned chemoembolisation, and 25 of 35 assigned conservative treatment died. Survival probabilities at 1 year and 2 years were 75% and 50% for embolisation; 82% and 63% for chemoembolisation, and 63% and 27% for conservative treatment.
Jordi Bruix comments: While we wait for confirmatory studies and from now on, chemoembolisation should become the standard approach for a selected group of candidates (unresectable intermediate hepatocellular carcinoma and preserved liver function).