Effective hepatic artery chemoembolization for advanced hepatocellular carcinoma with extensive tumour thrombus through the hepatic vein.
OBJECTIVE
Advanced hepatocellular carcinoma (HCC) with extensive tumour growth through the hepatic vein still has an extremely poor prognosis, even after cancer chemotherapy and/or transarterial embolization. Although aggressive surgical treatments using extracorporeal circulation and liver transplantation have been performed by some authors, the reported results were still unsatisfactory. In this study, we report the favourable result of hepatic artery chemoembolization and subsequent surgical resection in three patients with advanced HCC with extensive tumour thrombus through the hepatic vein.


RESULTS
Three irresectable patients with HCC with extensive tumour thrombus through the hepatic vein underwent hepatic artery chemoembolization with aclarubicin, mitomycin C, lipiodol and/or Gelfoam. After the reduction of tumour extent with hepatic artery chemoembolization, two of the three patients underwent surgical resection. These two patients are still alive at 59 and 21 postoperative months, respectively. In the other case, the extent of the tumour and functional reserve of the liver prevented us from performing surgical resection, but the patient is doing well 62 months after the initial treatment.


CONCLUSIONS
Hepatic artery chemoembolization with aclarubicin, mitomycin C, lipiodol and/or Gelfoam might be an effective treatment for irresectable advanced HCC with extensive tumour thrombus into the inferior vena cava or the right atrium through the hepatic vein. Radical surgical resection might be applicable for selected patients without high surgical risk after reducing tumour extent by hepatic artery chemoembolization.
Kashima
Y
Y
The First Department of Surgery, School of Medicine, Chiba University, Chuoh, Japan.
Miyazaki
M
M
Ito
H
H
Kaiho
T
T
Nakagawa
K
K
Ambiru
S
S
Shimizu
H
H
Furuya
S
S
Nakajima
N
N
D015250:Aclarubicin / Q000008:administration & dosage; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage; D006499:Hepatic Artery; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009360:Neoplastic Cells, Circulating; D011859:Radiography
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin; D015250:Aclarubicin; D007459:Iodized Oil