***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Transcatheter arterial chemoembolization ( TACE ) offers a survival benefit to patients with intermediate hepatocellular carcinoma ( HCC ) . A widely accepted TACE regimen includes administration of doxorubicin-oil emulsion followed by gelatine sponge — conventional TACE . Recently , a drug-eluting bead ( DC Bead ® ) has been developed to enhance tumor drug delivery and reduce systemic availability . This r and omized trial compares conventional TACE ( cTACE ) with TACE with DC Bead for the treatment of cirrhotic patients with HCC . Two hundred twelve patients with Child-Pugh A/B cirrhosis and large and /or multinodular , unresectable , N0 , M0 HCCs were r and omized to receive TACE with DC Bead loaded with doxorubicin or cTACE with doxorubicin . R and omization was stratified according to Child-Pugh status ( A/B ) , performance status ( ECOG 0/1 ) , bilobar disease ( yes/no ) , and prior curative treatment ( yes/no ) . The primary endpoint was tumor response ( EASL ) at 6 months following independent , blinded review of MRI studies . The drug-eluting bead group showed higher rates of complete response , objective response , and disease control compared with the cTACE group ( 27 % vs. 22 % , 52 % vs. 44 % , and 63 % vs. 52 % , respectively ) . The hypothesis of superiority was not met ( one-sided P = 0.11 ) . However , patients with Child-Pugh B , ECOG 1 , bilobar disease , and recurrent disease showed a significant increase in objective response ( P = 0.038 ) compared to cTACE . DC Bead was associated with improved tolerability , with a significant reduction in serious liver toxicity ( P < 0.001 ) and a significantly lower rate of doxorubicin-related side effects ( P = 0.0001 ) . TACE with DC Bead and doxorubicin is safe and effective in the treatment of HCC and offers a benefit to patients with more advanced disease BACKGROUND / AIMS Lipiodol chemoembolization is a widely used method of treatment in patients with unresectable hepatocellular carcinoma , but its efficacy is still debated . The aim of our study was to assess the efficacy of lipiodol chemoembolization in patients with unresectable hepatocellular carcinoma . METHODS Seventy-three patients with unresectable hepatocellular carcinoma , but without severe liver disease or portal vein occlusion , were r and omly assigned to receive either repeated lipiodol chemoembolization ( lipiodol , cisplatin ( 2 mg/kg ) , lecithin , and gelatin sponge injected into the hepatic artery ) plus tamoxifen ( 40 mg ) or tamoxifen alone . The main end-point was survival . RESULTS The 37 patients in the lipiodol chemoembolization group received 104 courses ( median 3 per patient ) . By 1 September 1996 , 58 patients had died : 30 in the lipiodol chemoembolization group and 28 in the tamoxifen group . There was no difference in survival between the two groups ( p=0.77 ) . The relative risk of death in the lipiodol chemoembolization plus tamoxifen group as compared to the tamoxifen group was 0.92 ( 95 % confidence interval 0.55 to 1.56 ) . At 1 year , survival was 51 % and 55 % , respectively . An objective tumoral response was more frequently observed in the lipiodol chemoembolization group than in the tamoxifen group ( 24 versus 5.5 % , respectively , p=0.046 ) . Lipiodol chemoembolization caused two deaths and induced signs of liver failure in 51 % of the patients assigned to this treatment . CONCLUSION In our r and omized study , lipiodol chemoembolization did not improve the survival of patients with unresectable hepatocellular carcinoma treated with tamoxifen A r and omized trial of hepatic arterial chemoembolization was conducted in 42 patients with unresectable hepatocellular carcinoma . These patients represented 41 % of patients with hepatocellular carcinoma seen during the inclusion period . In the remaining 59 % , 9 % had resectable tumours and 50 % had unresectable tumours with contraindication for chemoembolization . Patients received either repeated chemoembolization with gelfoam powder and doxorubicin ( group 1 ) or symptomatic treatment ( group 2 ) . There was no difference in age , prevalence of cirrhosis or staging according to Okuda between the two groups of patients . A complete tumour response ( assessed by arteriography , ultrasonography and serum alphafetoprotein ) was observed in four patients , and a partial response in three other patients from group 1 . Actuarial survival rates were 33 and 24 % in group 1 and 52 and 31 % in group 2 at 6 and 12 months , respectively ( differences were not significant -- logrank test ) . With the treatment used in our study , chemoembolization did not prolong the survival time of patients with unresectable hepatocellular carcinoma . There were , however , some complete or partial responses . The high spontaneous 1-year survival rate of untreated patients was probably due to the exclusion of the most severely ill patients . Our results do not support the use of this method of chemoembolization in the treatment of hepatocellular carcinoma This r and omized , controlled trial assessed the efficacy of transarterial Lipiodol ( Lipiodol Ultrafluide , Laboratoire Guerbet , Aulnay-Sous-Bois , France ) chemoembolization in patients with unresectable hepatocellular carcinoma . From March 1996 to October 1997 , 80 out of 279 Asian patients with newly diagnosed unresectable hepatocellular carcinoma fulfilled the entry criteria and r and omly were assigned to treatment with chemoembolization using a variable dose of an emulsion of cisplatin in Lipiodol and gelatin-sponge particles injected through the hepatic artery ( chemoembolization group , 40 patients ) or symptomatic treatment ( control group , 40 patients ) . One patient assigned to the control group secondarily was excluded because of unrecognized systemic metastasis . Chemoembolization was repeated every 2 to 3 months unless there was evidence of contraindications or progressive disease . Survival was the main end point . The chemoembolization group received a total of 192 courses of chemoembolization with a median of 4.5 ( range , 1 - 15 ) courses per patient . Chemoembolization result ed in a marked tumor response , and the actuarial survival was significantly better in the chemoembolization group ( 1 year , 57 % ; 2 years , 31 % ; 3 years , 26 % ) than in the control group ( 1 year , 32 % ; 2 years , 11 % ; 3 years , 3 % ; P = .002 ) . When adjustments for baseline variables that were prognostic on univariate analysis were made with a multivariate Cox model , the survival benefit of chemoembolization remained significant ( relative risk of death , 0.49 ; 95 % CI , 0.29 - 0.81 ; P = .006 ) . Although death from liver failure was more frequent in patients who received chemoembolization , the liver functions of the survivors were not significantly different . In conclusion , in Asian patients with unresectable hepatocellular carcinoma , transarterial Lipiodol chemoembolization significantly improves survival and is an effective form of treatment BACKGROUND The aim of our study was to compare the efficacy and safety of : 1 ) transarterial chemolipiodolization with gelatin sponge embolization vs chemolipiodolization without embolization , and 2 ) chemolipiodolization with triple chemotherapeutic agents vs epirubicin alone . METHODS A single-blind , three parallel arm , r and omized trial was conducted at three clinical centers with patients with biopsy-confirmed unresectable hepatocellular carcinoma . Arm 1 received triple-drug chemolipiodolization and sponge embolization , whereas Arm 2 received triple-drug chemolipiodolization only . Patients in arm 3 were treated with single-drug chemolipiodolization and sponge embolization . We compared overall survival and time to progression . Event-time distributions were estimated by the Kaplan-Meier method . All statistical tests were two-sided . RESULTS From July 2007 to November 2009 , 365 patients ( Arm 1 : n = 122 ; Arm 2 : n = 121 ; Arm 3 : n = 122 ) were recruited . The median tumor size was 10.9 cm ( range = 7 - 22 cm ) , and 34.5 % had macrovascular invasion . The median survivals and time to progression in Arm 1 , Arm 2 , and Arm 3 were 10.5 and 3.6 months , 10.1 and 3.1 months , and 5.9 and 3.1 months , respectively . Survival was statistically significantly better in Arm 1 than in Arm 3 ( P < .001 ) , whereas there was no statistically significant difference between Arm 1 and Arm 2 ( P = .20 ) . Objective response rates were 45.9 % , 29.7 % , and 18.9 % for Arm 1 , Arm 2 , and Arm 3 , respectively . CONCLUSIONS Chemolipiodolization played an important role in transarterial chemoembolization , and the choice of chemotherapy regimen may largely affect survival outcomes . However , the removal of embolization from chemoembolization might not statistically significantly decrease survival This r and omized , controlled trial assessed the effect of transarterial embolization ( TAE ) ( without associated chemotherapy ) on the survival of patients with nonsurgical hepatocellular carcinoma ( HCC ) . Eighty consecutive patients were r and omized to treatment with embolization ( Group A , n = 40 ) , or to symptomatic treatment ( Group B , n = 40 ) , there being no differences between both groups regarding the degree of liver function impairment and tumor stage . Eighty‐two percent of the patients presented a self‐limited postembolization syndrome , without treatment‐related mortality . Fifty‐five percent of the treated cases exhibited a partial response , which result ed in a lower probability of tumor progression during follow‐up ( 57 % vs. 77 % at 1 year ; P < .005 ) . However , after a median follow‐up of 24 months ( 30 deaths in each group ) , there are no differences in survival ( Group A : 49 % and 13 % ; Group B : 50 % and 27 % , at 2 and 4 years , respectively ; P = .72 ) . The absence of differences was maintained even when dividing patients according to Child‐Pugh 's grade , Okuda stage , or performance status test ( PST ) . Furthermore , there were no differences in the probability of complications or in the need of hospital admissions . In conclusion , TAE has a marked antitumoral effect associated to a slower growth of the tumor , but it does not improve the survival of patients with nonsurgical HCC Background Stimulation of vascular endothelial growth factor ( VEGF ) has been observed following transarterial chemoembolization ( TACE ) in hepatocellular cancer ( HCC ) and may contribute to tumor regrowth . This pilot study examined whether intravenous ( IV ) bevacizumab , a monoclonal antibody against VEGF , could inhibit neovessel formation after TACE . Methods 30 subjects with HCC undergoing TACE at a single academic institution were r and omized with a computer-generated allocation in a one to one ratio to either bevacizumab at a dose of 10 mg/kg IV every 14 days beginning 1 week prior to TACE ( TACE-BEV arm ) or observation ( TACE-O arm ) . Angiography was performed with TACE at day 8 , and again at weeks 10 and 14 . Repeat TACE was performed at week 14 if indicated . TACE-BEV subjects were allowed to continue bevacizumab beyond week 16 . TACE-O subjects were allowed to cross-over to bevacizumab at week 16 in the setting of progressive disease . The main outcome measure was a comparison of neovessel formation by serial angiography . Secondary outcome measures were progression free survival ( PFS ) at 16 weeks , overall survival ( OS ) , bevacizumab safety , and an analysis of VEGF levels before and after TACE with and without  bevacizumab . Results Among the 30 subjects enrolled , 9 of 15 r and omized to the TACE-O arm and 14 of 15 r and omized to the TACE-BEV arm completed all 3 angiograms . At week 14 , 3 of 9 ( 33 % ) TACE-O subjects and 2 of 14 ( 14 % ) TACE-BEV subjects demonstrated neovascularity . The PFS at 16 weeks was 0.19 in the TACE-O arm and 0.79 in the TACE-BEV arm ( p = 0.021 ) . The median OS was 61 months in the TACE-O arm and 49 months in the TACE-BEV arm ( p = 0.21 ) . No life-threatening bevacizumab-related toxicities were observed . There were no substantial differences in  bevacizumab pharmacokinetics compared to historical controls . Bevacizumab attenuated the increase in VEGF observed post-TACE . Conclusions IV beva 
    Output:
    
Liver enzyme abnormalities were the most commonly observed AE , followed by the symptoms associated with postembolization syndrome .