title: Induction of long-term remission in advanced hepatocellular carcinoma with percutaneous isolated liver chemoperfusion.
abstract: OBJECTIVE
  The aim of this study was to report the long-term results of percutaneous isolated liver chemoperfusion with hepatic venous isolation and charcoal hemoperfusion (HVI-CHP) in patients with multiple advanced hepatocellular carcinoma (HCC).
  
  
  BACKGROUND
  The results of conventional chemotherapy including regional and systemic chemotherapy in patients with HCC remain dismal, and long-term survivors after treatment are rare among patients with multiple advanced HCC. In an effort to improve this situation, we previously developed a novel system of percutaneous isolated liver chemoperfusion with HVI-CHP.
  
  
  METHODS
  Doxorubicin (60 to 150 mg/m2) was administered via the hepatic artery, under conditions of extracorporeal drug elimination by HVI-CHP in 28 consecutive patients with advanced HCC (39 total treatments). Hepatic venous isolation and charcoal hemoperfusion was accomplished mainly by the single catheter technique using a newly developed 4-lumen-balloon catheter, which was used to isolate and capture total hepatic venous outflow and, at the same time, to direct the filtered blood to the right atrium.
  
  
  RESULTS
  Complete remission was achieved in five patients, of which four received repeated treatments (two or three times). Although 1 of 5 patients with complete remission died of pulmonary metastases at 8 months, the other 4 remain healthy and free of disease at 20, 24, 27, and 42 months after the first treatment. Partial responses were observed in 12 patients. Duration of response in responders (complete and partial) with repeated treatments was significantly longer than that with a single treatment (p = 0.01). The overall survival rate by the Kaplan-Meier method was 39.7% at 5 years. The treatments were well-tolerated, and the primary side effects were mild to moderate chemical hepatitis and reversible myelosuppression.
  
  
  CONCLUSIONS
  The results suggest that percutaneous isolated liver chemoperfusion with HVI-CHP is an effective palliative treatment in the majority of patients and yields long-term complete remission in some patients with multiple advanced HCC.
authors.affiliation: Department of Surgery I, Kobe University School of Medicine, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ku
authors.forename: T
authors.initials: T
authors.lastname: Iwasaki
authors.forename: T
authors.initials: T
authors.lastname: Fukumoto
authors.forename: M
authors.initials: M
authors.lastname: Tominaga
authors.forename: S
authors.initials: S
authors.lastname: Muramatsu
authors.forename: N
authors.initials: N
authors.lastname: Kusunoki
authors.forename: T
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Y
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Y
authors.initials: Y
authors.lastname: Kuroda
authors.forename: Y
authors.initials: Y
authors.lastname: Saitoh
authors.forename: M
authors.initials: M
authors.lastname: Sako
authors.forename: S
authors.initials: S
authors.lastname: Matsumoto
authors.forename: S
authors.initials: S
authors.lastname: Hirota
authors.forename: H
authors.initials: H
authors.lastname: Obara
mesh_terms: D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality; D002404:Catheterization; D002606:Charcoal / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage*; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012074:Remission Induction; D016019:Survival Analysis
chemical_list: D000903:Antibiotics, Antineoplastic; D002606:Charcoal; D004317:Doxorubicin