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

Abstract

BACKGROUND The prognosis of patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is extremely poor. The aim of this study was to elucidate the efficacy of hepatic arterial infusion chemotherapy (HAIC) for patients with advanced HCCs. METHODS Forty‐eight HCC patients with PVTT were treated by HAIC via a subcutaneously implanted injection port. Of these, 14 had PVTT in the second portal branch and 34 patients had PVTT in the first portal branch or in the main portal trunk. One course of chemotherapy consisted of daily cisplatin (7 mg/m2 for 1 hour on Days 1–5) followed by 5‐fluorouracil (170 mg/m2 for 5 hours on Days 1–5). Patients were scheduled to receive four serial courses of HAIC. Responders were defined as having either a complete response (CR) or partial response (PR) and nonresponders were defined as exhibiting stable disease or progressive disease. The prognosis after HAIC and factors related to survival were analyzed. RESULTS Following HAIC, 4 and 19 patients exhibited a CR and PR, respectively (response rate = 48%). The 1, 2, 3, and 5‐year cumulative survival rates of 48 patients treated with HAIC were 45%, 31%, 25%, and 11%, respectively. Median survival periods for 23 responders and 25 nonresponders were 31.6 (range, 8.3–76.9) months and 5.4 (1.9–29.0) months, respectively. Therapeutic effect (P < 0.001) and hepatic reserve capacity (P = 0.021) were identified as significant prognostic factors by univariate analysis. Multivariate analysis identified only therapeutic effect as being significantly related to survival. CONCLUSIONS HAIC using low‐dose cisplatin and 5‐fluorouracil may be a useful therapeutic option for patients with advanced HCC with PVTT. HCC patients with PVTT who respond to HAIC could certainly have survival benefits. Cancer 2002;95:588–95. © 2002 American Cancer Society. DOI 10.1002/cncr.10694

Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

“…10,44,45 The best survival in the current study may have been achieved by the perfect objective response of the tumors and the reserved liver function.…”

“…Recently, some authors reported that even patients with liver cirrhosis were treated effectively with TAI (cisplatin and 5-fluorouracil). 10,11 Moreover, interferon ␣ was added to TAI to augment the cytotoxic effects. 32,33 In those studies, the objective response rates were 33-73%; the overall survival rates at 1 years and 2 years were 24 -45% and 15-31%, respectively; and the median survival was 7.5-10.2 months.…”

“…6,10,11,32,33,[42][43][44][45] Furthermore, 75% of the patients in the current series had bulky tumors that measured Ն 50 mm in greatest dimension. This result suggests that proton beam therapy alone can be a curative modality of treatment for patients who have HCC with PVTT.…”

“…6,10,11,29,[31][32][33][42][43][44][45] Five of 12 patients survived for Ͼ 4 years after treatment, and, 3 patients remain alive without disease. To our knowledge, this is the first report to present excellent survival for patients who had HCC with PVTT.…”

Effect of Metabolic Inhibitors on the Hepatic Disposition of 5-Fluorouracil after Application to the Rat Liver Surface

“…4) Although chemotherapy has been applied to treat the advanced or recurrent HCC, most of anticancer drugs cannot exert the desired effect on HCC because of high chemoresistance rate. 5,6) Local therapies such as percutaneous ethanol injection, 7,8) intratumoral injection [9][10][11] and intra-arterial infusion 12) have been performed to enhance the therapeutic effect of anticancer drugs on HCC. However, optimal delivery of anticancer drugs to HCC lesion is difficult through these routes because of distribution in the normal surrounding tissue or rapid efflux into the systemic circulation from the injection site.…”