title: Hepatic arterial embolization with microencapsulated mitomycin C for unresectable hepatocellular carcinoma in cirrhosis.
abstract: From 1986 to 1988, 35 patients with a hepatoma judged either inoperable or unresectable because of coexistent cirrhosis were treated with hepatic arterial embolization of mitomycin C microcapsules. Five of these 35 patients (14.5%) could not be treated because of inability to selectively cannulate the hepatic artery and were therefore excluded from the evaluation (feasibility rate, 86%). There were 24 men and six women with a median age of 57 years (range, 47 to 79) who could be classified as Okuda I (14 pts) or Okuda II (16 pts) and Child Class A:18 and Child Class B:12 in the remaining patients. A median dose of 0.5 mg mitomycin C/kg was administered to each subject and the treatment was repeated at 5 to 6 week intervals. Seventy courses were administered to these 30 patients (median, two courses/patient; range, 1 to 4). Minor complications were frequent (63%) but always either resolved spontaneously or after appropriate medical treatment. Neither severe renal nor hepatic toxicity was observed. No specific treatment related mortality was observed. When alpha-fetoprotein levels and tumor volume were assessed to evaluate the response to treatment using established criteria for identifying a response, an objective response was found in 43% of the cases treated. The actuarial median survival was 7 months and the 1-year actuarial survival was 36% (51% for those rated as Child Class A and 0% for those identified as Child Class B, P = 0.04 and 78% rated as Okuda Types I and 0% Okuda type II, P = 0.0001). The excellent quality of life and the increased survival rate experienced after mitomycin C microcapsule embolization suggest that this treatment modality can be used successfully in patients seen in the West who have unresectable hepatoma.
authors.affiliation: Divisione di Oncologia Chirugica A, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
authors.forename: R A
authors.initials: RA
authors.lastname: Audisio
authors.forename: R
authors.initials: R
authors.lastname: Doci
authors.forename: V
authors.initials: V
authors.lastname: Mazzaferro
authors.forename: L
authors.initials: L
authors.lastname: Bellegotti
authors.forename: M
authors.initials: M
authors.lastname: Tommasini
authors.forename: F
authors.initials: F
authors.lastname: Montalto
authors.forename: A
authors.initials: A
authors.lastname: Marchianò
authors.forename: A
authors.initials: A
authors.lastname: Piva
authors.forename: C
authors.initials: C
authors.lastname: DeFazio
authors.forename: B
authors.initials: B
authors.lastname: Damascelli
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D003692:Delayed-Action Preparations; D004621:Embolization, Therapeutic; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin; D008937:Mitomycins / Q000008:administration & dosage* / Q000627:therapeutic use; D016019:Survival Analysis
chemical_list: D003692:Delayed-Action Preparations; D008937:Mitomycins; D016685:Mitomycin