Intra-arterial combination chemotherapy induces long-term survival for hepatocellular carcinoma


Portal venous tumor thrombus (PVTT) is a crucial factor that can worsen the prognosis of patients with hepatocellular carcinoma (HCC). It often leads to extensive spreading of the tumor throughout the liver, and can increase portal venous blood pressure, resulting in the fatal rupture of esophageal varices, and can decrease portal flow which causes ascites, jaundice, hepatic encephalopathy, and liver failure. However, there is no effective useful therapy for HCC combined with PVTT. Therefore, there is an urgent need for new and active drugs and combination chemotherapy of advanced HCC.
A total of 10 consecutive patients with Stage IVA HCC accompanied by PVTT were studied prospectively to examine the efficacy of treatment by intra-arterial infusion of a chemotherapeutic agents consisting of etoposide, carboplatin, epirubicin and pharmacokinetic modulating chemotherapy by 5-FU and enteric-coated tegafur/uracil by Ishikawa, et al.
The median survival time after the therapy was 457.2 days; the 1-year survival rate was 70 %. Adverse reactions were tolerable.
Although the prognosis of most patients with HCC by PVTT is poor, our combination chemotherapy may induce long-term survival and is an effective treatment and produced anti-tumor activity with tolerable adverse effects in patients for advanced HCC accompanied by PVTT.
Intra-arterial combination chemotherapy is useful and inducing long-term survival for advanced HCC accompanied by PVTT. Further prospective randomized clinical trials of chemotherapy for HCC with PVTT are needed.