Hongtao Hu

 Department of Radiology and Research Institute ofRadiology, The Affiliated Cancer Hospital of Zhengzhou University, Henan CancerHospital

Objective:To investigate the safety, clinicalefficacy, and long-term outcome of TACE plus As₂O₃ intravenousinfusion for HCC patients with pulmonary metastases. Method: BetweenOctober2010 and April 2011, 60 consecutive patients who were diagnosed withadvanced HCC with pulmonary metastasis were randomized 1:1 into the treatment (groupA) and control (group B) groups. Group A underwent TACE for the primary livertumor and then underwent As₂O₃ treatment, whereas Group Bunderwent TACE alone. There were no significant differences in the baselinepatient characteristics between the groups. In group A, 21 patients had>3pulmonary metastatic tumor nodules and 9 had ≤ 3 nodules. Nine patients hadpulmonary metastatic tumors>2 cm, and 21 had tumors ≤ 2 cm. In group B, 20patients had>3 pulmonary metastatic tumor nodules and 10 had ≤ 3 nodules.Twelve patients had pulmonary metastatic tumors>50px, and 18 had tumors ≤ 2 cm. TACEtreatment was repeated if necessary and terminated if the patient could nottolerate the procedure because of a decline in clinical status. Group Aunderwent a continuous 5-hour intravenous infusion of 10 mg/day As₂O₃and continued for 14 days as one course of treatment. All patients in group Aunderwent at least 4 treatment courses. Result: In group A (treatmentgroup), the pulmonary metastatic tumor response of CR was obtained in 2patients, PR in 6, SD in 10, and PD in 12. A clinically effective rate (CR+PR)was achieved in 26.7% (8 of30 patients), and the clinical benefit rate (CR+PR+SD)was 60% (18 of 30patients). In group B (control group), no patients had a CR orPR, 5 had SD, and 25 had PD. The clinically effective rate was 0% (0 of 30patients), and the clinical benefit rate was 16.7% (5 of 30 patients).According to the correlation analysis, there was an inverse relationshipbetween As₂O₃ efficacy and metastatic tumor load. Duringthe median follow-up period of 23 months (range, 3–44 months), the mediansurvival time (MST) was 14 months in group A, and 10 months in group B. Theoverall 1-year survival was 56.7% (17/30) in group A and 36.7% (11/30) in groupB. The overall 2-years survival was 16.7% (5/30) in group A and 3.3% (1/30) ingroup B ≤ 3 nodules. Twelve patients had pulmonary metastatic tumors>50px,and 18 had tumors ≤ 2 cm. TACE treatment was repeated if necessary andterminated if the patient could not tolerate the procedure because of a declinein clinical status. Group A underwent a continuous 5-hourintravenous infusionof 10 mg/day As₂O₃ and continued for 14 days as onecourse of treatment. All patients in group A underwent at least 4 treatmentcourses. Conclusion: TACE plus an intravenous infusion of As₂O₃effectively controlled pulmonary metastasis and prolonged OS in patients withHCC. We envisage that these results might help to assist clinicians indetermining the optimal treatment for HCC patients with pulmonary metastases.

Key Words: TACE  As₂O₃  HCC with pulmonary metastasis