Different Protocols for Repeated Transarterial Chemoembolization in the Treatment of Patients With Hepatocellular Carcinoma

Inclusion criteria

• Patients with histologically confirmed HCC with unresectable disease without extrahepatic metastases;
• HCC with no previous treatment;
• age between 18 and 75 years;
• Life expectancy of at least 8 weeks;
• main tumor size greater than 5 cm;
• adequate hematologic function (platelet count: >60 × 109 platelets/L; hemoglobin: >90g/L; and prothrombin time: <3 seconds above control);
• adequate renal function (serum creatinine: ≤1.5 × upper limit of normal);
• Child-Pugh classification A or B grade;
• Barcelona Clinic Liver Cancer (BCLC) stage B or C;
• Eastern Co-operative Group performance status of zero or one.

Exclusion criteria

• a hypovascular tumor (defined as a tumor with all its parts less contrast-enhanced than the nontumorous liver parenchyma on arterial phase computed tomography scans);
• diffuse-type HCC;
• evidence of hepatic decompensation including esophageal or gastric variceal bleeding or hepatic encephalopathy;
• severe underlying cardiac or renal diseases;
• color Doppler ultrasonography showing portal vein tumor thrombosis with complete main portal vein obstruction without cavernous transformation; or obstructive jaundice.