Emulsion Versus Suspension in Chemoembolization for Hepatocellular Carcinoma

Inclusion criteria

1. Written informed consent
2. Age above 18 years
3. HCC unsuitable for resection or ablation
4. Child-Pugh A cirrhosis
5. Eastern Cooperative Oncology Group performance score 0 or 1
6. BCLC A or B
7. No previous treatment for HCC except for liver resection
8. HCC diagnosed by typical enhancement patterns on cross sectional imaging or histology.
9. No extra-hepatic involvement on non-enhanced CT thorax and triphasic contrast enhanced CT abdomen.
10. No invasion of portal vein or hepatic vein
11. Massive expansive tumor morphology with measurable lesion on CT (characterized by well-defined spherical or globular configuration, with or without tumor capsule or satellite lesions)
12. Total tumor mass \< 50% liver volume
13. Size of any individual tumor greater than or equal to 10cm in largest dimension
14. Serum creatinine \< 130 umol/L or Creatinine clearance \> 55 ml/min.

Exclusion criteria

1. Known active malignancy within the last 3 years
2. History of acute tumor rupture presenting with hemo-peritoneum
3. Biliary obstruction not amenable to percutaneous or endoscopic drainage
4. History of hepatic encephalopathy
5. Intractable ascites not controllable by medical therapy
6. History of variceal bleeding within last 3 months
7. Infiltrative tumor morphology (characterized by ill- defined tumor margin and amorphous configuration) or diffuse tumor morphology (characterized by large number of small nodules)
8. Un-correctable Arterio-portal venous shunt affecting \>1 hepatic segment on CT
9. Arterial-hepatic venous shunt with hepatic vein opacified in arterial phase on CT