Hepatic arterial infusion chemotherapy for hepatocellular carcinoma with tumor thrombosis of the portal vein

Abstract

AIM: Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is associated with poor prognosis. The aim of this prospective study was to evaluate the efficacy of hepatic arterial infusion chemotherapy (HAIC) for patients with this disease. METHODS:Eighteen HCC patients with PVTT were treated with HAIC via a subcutaneously implanted injection port. A course of chemotherapy consisted of daily cisplatin (10 mg for one hour) followed by 5-fluorouracil (250 mg for five hours) for five continuous days within a given week. The patients were scheduled to receive four consecutive courses of HAIC. Responders were defined in whom either a complete or partial response was achieved, while non-responders were defined based on stable or progressive disease status. The prognostic factors associated with survival after treatment were analyzed. RESULTS:Six patients exhibited partial response to this form of HAIC (response rate = 33 %). The 3, 6, 9, 12 and 18-month cumulative survival rates for the 18 patients were 83 %, 72 %, 50 %, 28 %, and 7 %, respectively. Median survival times for the six responders and 12 non-responders were 15.0 (range, 11-18) and 7.5 (range, 1-13) months, respectively. It was demonstrated by both univariate and multivariate analyses that the therapeutic response and hepatic reserve function were significant prognostic factors.

Systemic gemcitabine combined with intra-arterial low-dose cisplatin and 5-fluorouracil for advanced hepatocellular carcinoma: Seven cases

“…With regard to the adverse reactions to intra-arterial low-dose cisplatin and 5-FU, nausea, loss of appetite, peptic ulcer, leukopenia, thrombocytopenia, deterioration of hepatic function, and renal damage have been reported in previous studies [11][12][13] . Most of these adverse reactions were considered to be relatively mild and no patient required administration of G-CSF or blood transfusion.…”

“…The median survival time of HCC patients with PVTT in the trunk is reported to be about 90 d with supportive care [28] . Three recent studies have reported the efficacy and survival benefits of combination therapy of intra-arterial low-dose cisplatin and 5-FU for patients with advanced HCC [11][12][13] . These studies included nine, 48 and 18 patients with advanced HCC and PVTT (in the second branch, first branch, or trunk), who showed objective response rates of 44% (4/9 patients), 48% (23/48 patients) and 33% (6/18 patients), respectively.…”

“…However, such treatment results in a low response rate (13% and 22%). Several groups have used low-dose cisplatin and 5-FU for advanced HCC with PVTT, and have reported favorable results [11][12][13] . Several recent studies have reported the survival benefits of combination therapy of intra-arterial 5-FU and subcutaneous interferon alpha (IFN-α) therapy for advanced HCC with PVTT [14][15][16][17][18] .…”

Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis

“…In previous reports, the response rate and disease control rate of HAIC in advanced HCC patients with PVTT [11,[24][25][26] were 33%-52% and 47%-77%, respectively. The median OS was 7-10 mo in those studies.…”

Retrospective evaluation of tumor-mass-reduction therapy for the prognosis of recurrent hepatocellular carcinoma

“…Any subjects whose hepatic tumors are diagnosed as other than HCC or who have extrahepatic metastases at the entry were excluded from this study. The modalities of treatment include transcatheter arterial embolization (TAE) [14,[17][18][19], transcatheter arterial infusion (TAI) chemotherapy [20][21][22][23][24], percutaneus ethanol injection (PEI) [25], percutaneus microwave coagulation therapy (PMCT) [11], radiofrequency ablation (RFA) [26][27][28], radiation therapy (RT) [29][30][31][32], and hepatic resection [5]. No antiviral drugs were given as an adjuvant therapy to any patient in this study.…”