hepatic arterial embolization with microencapsulated mitomycin C for unresectable hepatocellular carcinoma in cirrhosis

Abstract

From 1986 to 1988, 35 patients with a hepatoma judged either inoperable or unresectable because of coexistent cirrhosis were treated with hepatic arterial embolization of mitomycin C microcapsules. Five of these 35 patients (14.5%) could not be treated because of inability to selectively cannulate the hepatic artery and were therefore excluded from the evaluation (feasibility rate, 86%). There were 24 men and six women with a median age of 57 years (range, 47 to 79) who could be classified as Okuda I (14 pts) or Okuda II (16 pts) and Child Class A:18 and Child Class B:12 in the remaining patients. A median dose of 0.5 mg mitomycin C/kg was administered to each subject and the treatment was repeated at 5 to 6 week intervals. Seventy courses were administered to these 30 patients (median, two courses/patient; range, 1 to 4). Minor complications were frequent (63%) but always either resolved spontaneously or after appropriate medical treatment. Neither severe renal nor hepatic toxicity was observed. No specific treatment related mortality was observed. When alpha-fetoprotein levels and tumor volume were assessed to evaluate the response to treatment using established criteria for identifying a response, an objective response was found in 43% of the cases treated. The actuarial median survival was 7 months and the 1-year actuarial survival was 36% (51% for those rated as Child Class A and 0% for those identified as Child Class B, P = 0.04 and 78% rated as Okuda Types I and 0% Okuda type II, P = 0.0001). The excellent quality of life and the increased survival rate experienced after mitomycin C microcapsule embolization suggest that this treatment modality can be used successfully in patients seen in the West who have unresectable hepatoma.

Intratumoral cancer chemotherapy and immunotherapy: opportunities for nonsystemic preoperative drug delivery

“…Thus, combining partial embolization of the hepatic artery with delivery of a drug}oil emulsion has signi® cantly prolonged survival of patients with HCC (Yamashita et al 1991;Bismuth et al 1992;Bronkowski et al 1994). Several reports have described chemoembolization with various drug-loaded microspheres delivered through the hepatic arterial branch and trapped in the tumour capillary bed (Fujimoto et al 1985;Ichihara et al 1989;Audisio et al 1990;Beppu et al 1991).…”

Implantation treatment method of slow release anticancer doxorubicin containing hydroxyapatite (DOX-HAP) complex. A basic study of a new treatment for hepatic cancer

“…However, there is a demand for a treatment which has a less liver -and general toxicity or systemic side effect, in addition to the local anticancer effect. Targeting therapies, using a microcapsule, fat, and lipiodol methods have recently improved (Audisio et al, 1990;Gregoriadis, 1977;Kato, 1983;Kato et al, 1980Kato et al, , 1984Konno et al, 1983Konno et al, , 1984Widder et al, 1979). These methods were made possible by primary targeting through the nutrient artery of the tumour and complete secondary targeting by adding the embolisation effect.…”

Μελέτη Της Αγγειογένεσης Σε Ασθενείς Με Καρκίνο Του Ήπατος

“…Η εφαρμογή της μεθόδου αντενδεικνείται σε ασθενείς με διάχυτη ηπατική νόσο, ηπατική ανεπάρκεια και θρόμβωση της πυλαιάς. Μελέτες [71][72][73][74][75] που εξετάζουν την αποτελεσματικότητα της μεθόδου έδειξαν ποσοστά ανταπόκρισης μικρότερα από 50%, ενώ δυο τυχαιοποιημένες μελέτες [76,77] έδειξαν όφελος στην επιβίωση ασθενών που υποβλήθηκαν σε χημειοεμβολισμό.…”