Intra-arterial infusion chemotherapy in patients with advanced hepatocellular carcinoma with portal vein thrombosis.
- Author:
Jae Youn CHEONG
1
;
Kee Myung LEE
;
Sung Won CHO
;
Jae Han WON
;
Jai Keun KIM
;
Hee Jung WANG
;
Ki Baik HAHM
;
Jin Hong KIM
Author Information
1. Department of Gastroenterology, Genomic Research Center for Gastroenterology, Ajou University School of Medicine, Suwon, Korea. sung_woncho@hotmail.com
- Publication Type:Original Article
- Keywords:
Hepatocellular carcinoma;
Portal vein;
Thrombosis;
Intra-arterial infusion;
Chemotherapy
- MeSH:
Alkaline Phosphatase;
Carcinoma, Hepatocellular*;
Cisplatin;
Doxorubicin;
Drug Therapy*;
Drug Therapy, Combination;
Etoposide;
Female;
Fibrosis;
Fluorouracil;
Hope;
Humans;
Infusions, Intra-Arterial*;
Liver Failure;
Male;
Mitomycin;
Portal Vein*;
Prognosis;
Survival Rate;
Survivors;
Thrombosis;
Tomography, X-Ray Computed;
Venous Thrombosis*
- From:Korean Journal of Medicine
2004;67(1):40-48
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Advanced hepatocellular carcinoma (HCC) with portal vein thrombosis has a poor prognosis and has little hope for meaningful therapy. Transarterial chemoembolization has been performed as a treatment for advanced HCC, but some patients die from progressive liver failure after therapy. This study was undertaken to evaluate the therapeutic effects of intra-arterial infusion chemotherapy in advanced HCC with portal vein thrombosis, and to compare with those of systemic chemotherapy, and to identify prognostic factors that could affect survival. METHODS: Between January 1995 and January 2001, a total of 102 patients with advanced HCC having portal vein thrombosis (TNM stage IVa) were enrolled and divided into 3 groups; Group 1 (n=24) was managed with only conservative treatment, group 2 (n=25) received systemic combination chemotherapy consisting of 5-fluorouracil (FU) + Adriamycin + Mitomycin C, or 5-FU + Etoposide + Cisplatin, and group 3 (n=52) received intra-arterial infusion chemotherapy with 5-FU (250 mg for 5 days) + cisplatin (10 mg for 5 days) via implanted chemoport. RESULTS: One-year survival rates were 0%, 4%, 21%, and median survivals were 2-, 4-, 6 months in group 1, group 2, group 3, respectively (p=0.003). When we divide group 3 patients into long term survivors (more than 8 months) or short term survivors (less than 8 months), former had significantly lower level of serum AST (p=0.032) and alkaline phosphatase (p=0.033). Especially, all female patients (n=9) survived more than 8 months, and had a longer survival than male patients (p=0.000). Other favorable prognostic factors for survival were cirrhosis of Child-Pugh class A (p=0.003), only one major branch involvement of the portal vein by tumor (p=0.005), presence of enhancement of tumor portion in arterial phase of CT scan (p=0.044), presence of enhancement of non-tumor portion in portal phase of CT scan (p=0.029). CONCLUSION: Intra-arterial infusion chemotherapy achieved favorable results in advanced HCC with portal vein thrombosis and showed better survival in selected patients. This therapy can be tried as a treatment option for the management of advanced HCC.
