[A new method of intraarterial high dose chemotherapy for unresectable hepatocellular carcinoma--the effect of direct hemoperfusion under hepatic venous isolation].
We undertook hepatic artery infusion of high dose adriamycin (ADR) in three patients with unresectable hepatocellular carcinoma utilizing direct hemoperfusion (DHP) under hepatic venous isolation (HVI). 5 minutes continuous infusion of ADR at dosages of 100 and 150 mg/m2 was combined with DHP of 20 and 30 minutes, respectively. HVI was established by occlusions of suprahepatic and retrohepatic vena cava using a tourniquet tape and a cuff-cannula. During HVI, hepatic venous outflow was directed toward DHP and joined with the rest of the intra-caval blood before the centrifugal pump connected to a return cannula to the left axillary vein. Systemic levels of ADR were maintained less than 2 micrograms/ml during the treatments in three patients. The estimated drug removal rates were 72.3%, 51.2% and 31.1% respectively. Hematologic changes due to DHP were tolerable and transient. Highest values of serum transaminases were demonstrated on day 2 and rapidly recovered to the pretreatment levels within a week. Postoperative CT studies revealed also marked reduction in tumor size. We consider this method an attractive therapeutic option for patients with advanced hepatocellular carcinoma.
Ku
Y
Y
First Department of Surgery, Kobe University School of Medicine.
Saitoh
M
M
Fujiwara
S
S
Iwasaki
T
T
Nishiyama
H
H
Tominaga
M
M
Maekawa
Y
Y
Kasahara
H
H
Ohyanagi
H
H
Sako
M
M
D000368:Aged; D002244:Carbon; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage*; D006464:Hemoperfusion / Q000379:methods*; D006503:Hepatic Veins; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged
D002244:Carbon; D004317:Doxorubicin