***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: Purpose To prospect ively compare SIRT and DEB-TACE for treating hepatocellular carcinoma ( HCC ) . Methods From 04/2010–07/2012 , 24 patients with histologically proven unresectable N0 , M0 HCCs were r and omized 1:1 to receive SIRT or DEB-TACE . SIRT could be repeated once in case of recurrence ; while , TACE was repeated every 6 weeks until no viable tumor tissue was detected by MRI or contraindications prohibited further treatment . Patients were followed-up by MRI every 3 months ; the final evaluation was 05/2013 . Results Both groups were comparable in demographics ( SIRT : 8males/4females , mean age 72 ± 7 years ; TACE : 10males/2females , mean age 71 ± 9 years ) , initial tumor load ( 1 patient ≥25 % in each group ) , and BCLC ( Barcelona Clinic Liver Cancer ) stage ( SIRT : 12 × B ; TACE  1 × A , 11 × B ) . Median progression-free survival ( PFS ) was 180 days for SIRT versus 216 days for TACE patients ( p = 0.6193 ) with a median TTP of 371 days versus 336 days , respectively ( p = 0.5764 ) . Median OS was 592 days for SIRT versus 788 days for TACE patients ( p = 0.9271 ) . Seven patients died in each group . Causes of death were liver failure ( n = 4 SIRT group ) , tumor progression ( n = 4 TACE  group ) , cardiovascular events , and inconclusive ( n = 1 in each group ) . Conclusions No significant differences were found in median PFS , OS , and TTP . The lower rate of tumor progression in the SIRT group was nullified by a greater incidence of liver failure . This pilot study is the first prospect i ve r and omized trial comparing SIRT and TACE for treating HCC , and results can be used for sample size calculations of future studies AIM To assess whether the effectiveness of a combination of transarterial chemoembolization ( TACE ) and percutaneous ethanol injection ( PEI ) in the treatment of unresectable hepatocellular carcinoma ( HCC ) is superior to TACE alone a r and omized controlled trial was performed . METHODS The effect of combination therapy on long-term survival rates and duration of hospitalization was evaluated in 52 previously untreated HCCs , r and omly allocated to TACE-PEI ( 27 pts ) or TACE alone ( 25 pts ) . RESULTS The cumulative survival rate of the TACE group was 75.8 % at 6 mo , 62.9 % at 12 mo , and 18.0 % at 24 mo and of the TACE-PEI group 76.9 % , 61.5 % , and 38.7 % , respectively . Comparison of overall survival in both groups showed no statistically significant difference . Regarding the patients with HCCs Okuda stage I ( n = 26 ) , the median survival of the TACE-PEI group was significantly longer ( > 24 mo , median not yet reached in the study period ) compared to the TACE group ( 18.4 mo [ range 11.6 - 21.7 mo ] ; P = 0.04 ) . TACE-PEI reduced the relative risk for mortality to 0.4 ( 95%CI 0.15 - 0.96 ) compared to patients who received TACE alone . Median survival in patients with HCCs Okuda stage II or III was 5.0 mo in the TACE group ( 1.7 mo-not defined ) compared to 10.4 mo in the TACE-PEI group . CONCLUSION The combination TACE-PEI improved survival time compared to TACE alone . Our study revealed a statistically significant improved survival in HCCs Okuda stage I. Side effects were minor and the combination therapy did not prolong duration of hospitalization considerably BACKGROUND Assessment of the change in tumour burden is an important feature of the clinical evaluation of cancer therapeutics : both tumour shrinkage ( objective response ) and disease progression are useful endpoints in clinical trials . Since RECIST was published in 2000 , many investigators , cooperative groups , industry and government authorities have adopted these criteria in the assessment of treatment outcomes . However , a number of questions and issues have arisen which have led to the development of a revised RECIST guideline ( version 1.1 ) . Evidence for changes , summarised in separate papers in this special issue , has come from assessment of a large data warehouse ( > 6500 patients ) , simulation studies and literature review s. HIGHLIGHTS OF REVISED RECIST 1.1 : Major changes include : Number of lesions to be assessed : based on evidence from numerous trial data bases merged into a data warehouse for analysis purpose s , the number of lesions required to assess tumour burden for response determination has been reduced from a maximum of 10 to a maximum of five total ( and from five to two per organ , maximum ) . Assessment of pathological lymph nodes is now incorporated : nodes with a short axis of 15 mm are considered measurable and assessable as target lesions . The short axis measurement should be included in the sum of lesions in calculation of tumour response . Nodes that shrink to < 10 mm short axis are considered normal . Confirmation of response is required for trials with response primary endpoint but is no longer required in r and omised studies since the control arm serves as appropriate means of interpretation of data . Disease progression is clarified in several aspects : in addition to the previous definition of progression in target disease of 20 % increase in sum , a 5 mm absolute increase is now required as well to guard against over calling PD when the total sum is very small . Furthermore , there is guidance offered on what constitutes ' unequivocal progression ' of non-measurable/non-target disease , a source of confusion in the original RECIST guideline . Finally , a section on detection of new lesions , including the interpretation of FDG-PET scan assessment is included . Imaging guidance : the revised RECIST includes a new imaging appendix with up date d recommendations on the optimal anatomical assessment of lesions . FUTURE WORK A key question considered by the RECIST Working Group in developing RECIST 1.1 was whether it was appropriate to move from anatomic unidimensional assessment of tumour burden to either volumetric anatomical assessment or to functional assessment with PET or MRI . It was concluded that , at present , there is not sufficient st and ardisation or evidence to ab and on anatomical assessment of tumour burden . The only exception to this is in the use of FDG-PET imaging as an adjunct to determination of progression . As is detailed in the final paper in this special issue , the use of these promising newer approaches requires appropriate clinical validation studies 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 UNLABELLED Portal vein thrombosis is a poor prognostic factor in patients with hepatocellular carcinoma ( HCC ) and a contraindication for chemoembolization . Intra-arterial injection of 131I-iodized oil which does not modify arterial flow , is feasible in this condition . The aim of this prospect i ve r and omized controlled trial was to compare the efficacy of treatment with radiolabeled oil ( treated group ) versus medical support ( control group ) in patients with stage I or II HCC ( classification of Okuda ) with portal vein thrombosis . METHODS Twenty-seven HCC patients ( 26 males , 1 female ) , aged 53 - 79 yr , with portal vein thrombosis were r and omly assigned to Lipiocis group ( n = 14 ) or Control group ( n = 13 ) . Additional injections of radiolabeled oil were given 2 , 5 , 8 and 12 mo after initial therapy . Medical support treatment consisted of : tamoxifen ( n = 5 ) , 5 FU intravenously ( n = 1 ) , NSAIDs or corticosteroids ( n = 5 ) . Efficacy was evaluated according to survival rate ( Kaplan-Meier method ; log rank test ) , AFP serum values ( measured at 2 , 5 , 8 and 12 mo ) and angiography . RESULTS The two groups were comparable ( Child 's classification , Okuda 's classification , liver function tests , location of the thrombus ) . Tolerance was excellent in the Treated group . The actuarial survival curves were significantly different ( p < 0.01 ) between the two groups , the survival rates ( Cl 95 % ) at 3 , 6 and 9 mo being 71 % ( 48%-95 % ) , 48 % ( 12%-55 % ) , 7 % ( 1%-31 % ) for the Treated group ; and 10 % ( 1%-33 % ) , 0 % and 0 % for the Control group . CONCLUSION Intra-arterial hepatic injection of 131I-labeled iodized oil is a safe and effective palliative treatment of HCC with portal vein thrombosis Background : Transarterial chemoembolisation ( TACE ) has not been shown to be superior to bl and embolisation ( TAE ) for treatment of hepatocellular carcinoma ( HCC ) . Methods : We conducted a r and omised phase II/III trial in patients with untreated HCC . Patients were r  and omised to TAE with polyvinyl alcohol ( PVA ) particles alone or sequential TACE ( sTACE ) in which cisplatin 50 mg was administered intrarterially 4–6 h before PVA embolisation . Treatment was repeated 3-weekly for up to three treatments . The primary endpoint was overall survival and secondary endpoints were progression-free survival , toxicity and response . Target sample sizes for phase II and III were 80 and 322 . Results : The trial was terminated at phase II after 86 patients had been r and omised . Patients were well matched for prognostic criteria . All three planned treatments were given to 57.1 % ( TAE ) and 56.8 % ( TACE ) patients . Grade 3/4 toxicity occurred in 63.5 % and 83.7 % , respectively ( P=0.019 ) . End-of-treatment RECIST response ( CR+PR ) was 13.2 and 32.6 % ( P=0.04 ) ( mRECIST 47.3 % and 67.4 ) and median overall survival and progression-free survival was 17.3 vs 16.3 ( P=0.74 ) months and 7.2 vs 7.5 ( P=0.59 ) , respectively . Conclusion : Transarterial chemoembolisation according this novel schedule is feasible and associated with a higher response rate than TAE alone . The survival benefit of TACE over TAE remains unproven BACKGROUND & AIMS Transarterial chemoembolization with doxorubicin-eluting beads ( DC Bead ® ; DEB-TACE ) is effective in patients with Barcelona clinic liver cancer stage B hepatocellular carcinoma ( HCC ) . The multikinase inhibitor sorafenib enhances overall survival ( OS ) and time-to-tumor progression ( TTP ) in patients with advanced HCC . This exploratory phase II trial tested the efficacy and safety of DEB-TACE plus sorafenib in patients with intermediate stage HCC . METHODS Patients with intermediate stage multinodular HCC without macrovascular invasion ( MVI ) or extrahepatic spread ( EHS ) were r and omized 1:1 to DEB-TACE ( 150 mg doxorubicin ) plus sorafenib 400 mg twice daily or placebo . The primary endpoint was TTP by blinded central review . Secondary endpoints included time to MVI/EHS , OS , overall response rate ( ORR ) using modified response evaluation criteria in solid tumors , disease control rate ( DCR ) , time to unTACEable progression ( TTUP ) , and safety . RESULTS Of 307 patients r and omized , 154 received sorafenib and 153 received placebo .  Median TTP for subjects receiving sorafenib plus DEB-TACE or placebo plus DEB-TACE was similar ( 169 vs. 166 days , respectively ; hazard ratio ( HR ) 0.797 , p=0.072 ) . Median time to MVI/EHS ( 
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However , TACE , DEB-TACE , TARE and adjuvant systemic agents did not confer any survival benefit over bl and TAE alone ( moderate QoE , except low in case of TARE ) .
Chemo- and radio-embolization for unresectable hepatocellular carcinoma may improve tumour objective response and patient survival , but are not more effective than bl and particle embolization .
Chemoembolization combined with external radiotherapy or local liver ablation may significantly improve tumour response and patient survival rates over embolization monotherapies .