Treatment of Cancer of the Liver

Abstract

The factors influencing survival for patients with cancer of the liver were studied by reviewing the records of 414 patients operated on in a private oncology practice. Approximately half (47%) had colorectal metastasis; 17% had metastatic breast carcinoma, 14% had malignant hepatoma, 5% had metastatic melanoma, and the remainder had a variety of primary cancers. Eighty-two per cent of all patients had advanced liver disease when first diagnosed. One quarter of the patients had some type of resection; the remainder had abdominal exploration plus insertion of an infusion catheter into the hepatic artery. The postoperative mortality rate after liver resection for 108 patients was 6.5%. After resection, the most important prognostic factor influencing survival was the presence or absence of extrahepatic metastases. When possible, resection was by far the best treatment available, and the best results were seen in patients who had resection of a solitary lesion. For advanced disease, when resection was not possible, intra-arterial chemotherapy, primarily with 5-fluorouracil (5-FU), was associated with response rates of 36% for colorectal cancer, 45% for breast cancer, 13% for hepatocellular cancer, 12% for melanoma, and 14% for metastases from other primary sites. The patients who responded to infusion lived longer than those who did not respond. For example, at 18 months, 26% of the responders with colorectal cancer were alive, as were 50% of the responders with breast cancer and 40% of the responders with hepatocellular cancer. In contrast, at 18 months, there were no survivors among the nonresponders with colorectal, breast, or hepatocellular cancer. For those patients treated solely by infusion chemotherapy, the extent of disease in the liver was the most reliable factor in predicting the length of survival. However, very few patients treated in this manner lived longer than 3 years.

Isolated limb perfusion for melanoma: Effectiveness and toxicity of cisplatin compared with that of melphalan and other drugs

“…Aigner and colleagues [11] reported early remission rates of 30%--80% after ILP with dacarbazine in patients with measurable disease, but recurrences in all of them within 4 months. If the concept that dacarbazine is inactive until it has passed through the liver is Correct, then one possibility is that some of the effects seen Were produced by hyperthermia during ILP [42][43][44]. Another Possibility is that significant levels of dacarbazine were achieved in the systemic circulation, either during the ILP as a result of leakage or afterwards by release of drug from the tissues of the limb following its revascularization.…”

Characterization of an animal model of hepatic metastasis

“…H&E stained mouse liver1 week post induction of metastases. Tumour cell aggregates (arrow) in the hepatic sinusoids (S) represent early signs of metastatic liver involvement.…”

Treatment strategies for hepatic metastasis from colorectal cancer

“…Five‐year survivals in reported series range from 23%7 to 40%,8 and there is evidence that only one‐fourth to one‐third of patients who have a hepatic metastasis may benefit from resective surgery. In this regard, to our knowledge, multivariate analysis has been reported in only five other papers,1,4, and all those studies found that radical surgery (in which there was an absence of residual manifestation of an intrahepatic and/or extrahepatic disease and negative resection margins) was one of the most important factors for a better prognosis. Other factors identified to be important for an improved prognosis were the stage of primary tumor,1,9 the stage of hepatic metastasis,10 the number of metastases,1,4 the size of the lesion (not more than 8 cm), and the disease‐free interval before the hepatic resection 1…”