Survival after C-arm CT-assisted chemoembolization of unresectable hepatocellular carcinoma

Abstract Purpose To compare patient survival after transarterial chemoembolization with and without intraprocedural C-arm computed tomography (CT) in patients with unresectable hepatocellular carcinoma. Materials and methods We retrospectively reviewed the records of 130 patients with unresectable hepatocellular carcinoma who underwent lipiodol-based chemoembolization using a C-arm cone-beam system. We compared patients who underwent chemoembolization with angiography alone (69 patients; April 2005–July 2007) to those who underwent C-arm CT-assisted chemoembolization (61 patients; July 2007–April 2010). Overall and local progression-free survivals were compared using the Kaplan–Meier estimator with log-rank testing. Univariate and multivariate analyses were performed using the Cox proportional hazards model. Results Overall survival rates of patients who underwent chemoembolization with and without C-arm CT assistance were 94% and 79%, 81% and 65%, and 71% and 44% at 1, 2, and 3 years, respectively. Local progression-free survival rates of these patients were 43% and 27%, 31% and 10%, and 26% and 5% at 1, 2, and 3 years, respectively. Patients receiving C-arm CT-assisted chemoembolization had significantly higher overall ( P = 0.005) and local progression-free ( P = 0.003) survival rates than those receiving chemoembolization with angiography alone. Multivariate analysis showed that C-arm CT assistance was an independent factor associated with longer overall survival (hazard ratio, 0.40; P = 0.033) and local progression-free survival (hazard ratio, 0.25; P = 0.003). Conclusion C-arm CT usage in addition to angiography during transarterial chemoembolization prolongs survival in patients with unresectable hepatocellular carcinoma.