Korean J Med.  2004 Jul;67(1):40-48.

Intra-arterial infusion chemotherapy in patients with advanced hepatocellular carcinoma with portal vein thrombosis

• Cheong JY
• Lee KM
• Cho SW
• Won JH
• Kim JK
• Wang HJ
• Hahm KB
• Kim JH

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.

Keyword

Hepatocellular carcinoma; Portal vein; Thrombosis; Intra-arterial infusion; Chemotherapy

MeSH Terms

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*
Alkaline Phosphatase
Cisplatin
Doxorubicin
Etoposide
Fluorouracil
Mitomycin