Background. The authors have used percutaneous microwave coagulation therapy (PMCT) as a new percutaneous local treatment for single unresectable hepatocellular carcinoma (HCC) measuring 2 cm or less in greatest dimension (small HCC). PMCT was used to attempt a cure of the disease. In this study, the efficacy of this treatment was assessed.
Methods. PMCT was performed on 18 patients with single small HCC. A microwave electrode (custom‐made, 30‐cm long by 1.6‐mm thick) was inserted percutaneously into the tumor area under ultrasonic guidance. Microwaves at 60 W for 120 seconds were used to irradiate the tumor and surrounding area.
Results. After PMCT was administered, various image findings were correlated with tissue necrosis. At the tumor and surrounding area, ultrasonography showed echogenic change, contrast enhancement disappeared on contrast enhanced computed tomography, and magnetic resonance imaging (T2‐weighted image) showed decreased intensity in all cases after treatment. Complete necrosis of the tumor area in a specimen obtained from one patient who underwent hepatectomy after PMCT also was confirmed.
The treatment reduced levels of the tumor marker, alpha‐fetoprotein, which had been high in some patients. Although the follow‐up period was short (11‐33 months), 17 patients remain alive. Local recurrence in the treated area has not been detected, and no serious side effects or complications have been encountered.
Conclusions. PMCT may be an effective and safe treatment for small HCCs.
The depressant effect of interferon-alpha on drug metabolizing activity in the liver has been investigated in 12 patients with chronic active hepatitis B. 7-methoxy-coumarin (7-MC) O-demethylase and 7-ethoxycoumarin (7-EC) O-deethylase, in specimens obtained by liver biopsy, were measured before and after interferon treatment. 7-MC and 7-EC O-dealkylase activity were significantly reduced after interferon treatment, from 13.4 to 9.24 nmol.g-1 liver.min-1, and from 3.22 to 2.16 nmol.g-1 liver.min-1, respectively. The magnitude of the fall varied widely between individual patients. The study provides the first direct evidence that interferon-alpha can impair the activity of drug metabolizing enzymes in the human liver.
Summary We performed an experimental study on slow releasing anticancer drug implantation treatment as a new therapy for hepatocellular carcinoma. Hydroxyapatite (HAP) was chosen for the carrier material and doxorubicin hydrochloride (DOX) for anticancer agent. DOX-HAP was produced by adsorbing DOX to porous HAP particles of 1375 ± 125 gm diameter using the freeze drying method. In vitro experiments showed slow release of the drug resulting in the steady release of DOX from HAP for I month duration. In healthy white rabbits with DOX-HAP implantation in the liver, serum DOX was not detectable, and DOX release rate was stable at the implanted region after 7, 14, and 21 days. When DOX-HAP (DOX; 100mg kg-') was administered to mice with sarcoma 180, an improved survival rate was observed without acute toxicity.We also found that VX2 liver tumour growth on white rabbit was inhibited by implantation of DOX-HAP, without acute toxicity. We hope that DOX-HAP implantation therapy will open up new avenues for the treatment of hepatoma.
The effect of biliary endoprosthesis was evaluated in 13 patients with major bile duct obstruction secondary to invasion by hepatocellular carcinoma. In 12 patients major portal vein branches were also invaded by the tumors. After several days' instillation of nasobiliary or percutaneous drainage tubes to flush the bile ducts, biliary endoprosthesis was performed either endoscopically (N = 9) or percutaneously (N = 4). Significant decrease (less than 50% of initial values) of alkaline phosphatase and bilirubin levels was observed in eight and two patients on day 20, respectively. Twelve patients died of hepatic failure at 27-132 days (mean 60 days). One patient without portal vein involvement is currently alive at 300 days. Biliary endoprosthesis has a limited role in the palliation of bile duct obstruction secondary to hepatocellular carcinoma, and the prognosis may be influenced mainly by the underlying hepatic function.
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