Transarterial Liver‐Directed Therapies in Oncology

Abstract

A 50-year-old patient with a history of hepatitis C was recently found to have multiple liver masses. Imaging showed several 3 cm lesions with classic hypervascularity in the arterial phase and washout in the venous phase compatible with hepatocellular carcinoma (HCC). Alpha-fetal protein was also elevated. The patient did not qualify for transplant due to the multiple numbers of lesions involving both lobes. The lesions were unable to be surgically resected and unable to be ablated.• Outside of systemic therapy, what are the types of locoregional therapy that are available? If the lesions are inoperable and also unable to be ablated, a form of transarterial therapy can be considered. This procedure utilizes transarterial technique for chemoinfusion, bland embolization, chemoembolization, and radioembolization.Transarterial chemoinfusion (aka hepatic artery infusion (HAI)) utilizes the drug's first-pass extraction rate pharmacokinetic principle. For example, floxuridine has a hepatic extraction rate of 95%, which significantly reduces the systemic toxicity. Recently, Okusaka et al. (2009) demonstrated that for inoperable HCC, HAI was as effective as transarterial chemoembolization. This randomized phase III prospective study with 161 patients showed there was no statistical difference of median overall survival time between chemoembolization group (646 days) versus HAI group (679 days) (P = 0.383). They concluded that by adding embolization, it did not increase survival over HAI in patients with HCC.