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A combination therapy with transarterial chemo-lipiodolization and systemic chemo-infusion for large extensive hepatocellular carcinoma invading portal vein in comparison with conservative management.

AbstractPURPOSE:
Hepatocellular carcinoma (HCC) invading the portal vein is a medical challenge. We evaluated the therapeutic efficacy of a combination of transarterial and systemic chemo-infusion for large HCC with portal vein thrombosis (PVT) compared with conservative management.
PATIENTS AND METHODS:
This was a case-control cohort study of 103 consecutive patients with Child-Pugh class A who had a large (>10 cm) HCC with PVT. The patients were assigned to receive either combined transarterial epirubicin (50 mg/m(2)) plus cisplatin (60 mg/m(2)) chemo-lipiodolization and systemic 5-fluorouracil (200 mg/m(2)) chemo-infusion (ECF regimen) at monthly intervals (n=80) or conservative management (n=23).
RESULTS:
The objective tumor response (21.3 vs. 0%, P=0.011) and overall survival (8.7 vs. 3.5 months, P<0.001) were significantly better in the treatment group than in the conservative group. The prognostic factors for survival were tumor type (P=0.007), bilobar involvement (P=0.001), distant metastasis (P=0.009) and objective tumor response (P<0.001) for the treatment group. Survival benefits with the treatment were also maintained in each subgroup after stratification of these variables.
CONCLUSIONS:
This study suggests that when the hepatic function is preserved, a therapeutic strategy could be more beneficial than conservative management for such a large extensive HCC. As a therapeutic option, a combination therapy using ECF regimen may provide a significantly better tumor response and survival benefit in patients with large HCC invading the portal vein.
AuthorsJeong Won Jang, Si Hyun Bae, Jong Young Choi, Hyun Jong Oh, Min Soo Kim, So Yeon Lee, Chang Wook Kim, U Im Chang, Soon Woo Nam, Sang Bok Cha, Young Joon Lee, Ho Jong Chun, Byung Gil Choi, Jae Young Byun, Seung Kew Yoon
JournalCancer chemotherapy and pharmacology (Cancer Chemother Pharmacol) Vol. 59 Issue 1 Pg. 9-15 (Jan 2007) ISSN: 0344-5704 [Print] Germany
PMID16614848 (Publication Type: Clinical Trial, Comparative Study, Journal Article)
Chemical References
  • Antibiotics, Antineoplastic
  • Antimetabolites, Antineoplastic
  • Antineoplastic Agents
  • Epirubicin
  • Cisplatin
  • Fluorouracil
Topics
  • Adult
  • Aged
  • Antibiotics, Antineoplastic (administration & dosage)
  • Antimetabolites, Antineoplastic (administration & dosage)
  • Antineoplastic Agents (administration & dosage)
  • Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects, therapeutic use)
  • Carcinoma, Hepatocellular (drug therapy, pathology)
  • Case-Control Studies
  • Cause of Death
  • Cisplatin (administration & dosage)
  • Epirubicin (administration & dosage)
  • Female
  • Fluorouracil (administration & dosage)
  • Humans
  • Infusions, Intra-Arterial
  • Liver Diseases (drug therapy)
  • Liver Neoplasms (drug therapy, pathology)
  • Male
  • Middle Aged
  • Portal Vein (pathology)
  • Prognosis
  • Survival Analysis
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Venous Thrombosis (pathology)

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