Arsenic trioxide intravenous infusion combined with transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with pulmonary metastasis: Long-term outcome analysis

ObjectiveTo evaluate the safety, clinical efficacy, and long-term outcome of arsenic trioxide (As2O3) intravenous infusion for pulmonary metastases in patients with HCC. Materials and MethodsSixty consecutive patients who were diagnosed with advanced hepatocellular carcinoma (HCC) with pulmonary metastasis were randomized 1:1 into the treatment and control groups. Treatment group underwent transcatheter arterial chemoembolization (TACE) for the primary liver tumor and then underwent As2O3 treatment, whereas control group underwent TACE alone. The treatment group underwent a continuous 5-h intravenous infusion of 10mg/day As2O3. The course of As2O3 treatment was initiated 3-5days after TACE (to allow liver and gastrointestinal function to recover) and continued for 14 consecutive days. All patients in the treatment group underwent at least four treatment courses. Response to treatment was evaluated after four treatment courses. ResultIn treatment group, two patients had a complete response (CR), six had a partial response (PR), 10 had stable disease (SD), and 12 had progressive disease. A clinically effective rate (CR+PR) was achieved in 26.7%, and the clinical benefit rate (CR+PR+SD) was 60%. In the control group, no patients had a CR or PR, five had SD, and 25 had progressive disease. The clinically effective rate was 0%, and the clinical benefit rate was 16.7%. The overall 1-year survival was 56.7% in treatment group and 36.7% in control group. The overall 2-year survival was 16.7% in treatment group and 3.3% in control group. ConclusionTranscatheter arterial chemoembolization plus an intravenous infusion of As2O3 effectively controlled pulmonary metastasis and prolonged overall survival in patients with HCC compared with TACE alone.