[The hepatic artery injection chemotherapy and prostaglandin E1 administration for hepatocellular carcinoma invading the biliary tract with jaundice].
A 69-year-old man had radiofrequency ablation therapy (following RFA) for type C cirrhosis with hepatoma (following HCC) of S7 in November 2001. Afterward the patient was followed as an outpatient, but he had been admitted to our hospital due to jaundice confirmed in March 2004. His abdominal wall appeared to be soft and flat, and we could not detect a tumor mass by palpating either. Even though he exhibited no actual symptom of anemia, jaundice was found in the bulbar conjunctiva at the time of admission. Laboratory findings showed a mild inflammation and anemia on his admission, and biochemical data showed a rise of hepatobiliary enzyme with jaundice. A rise of tumor marker (AFP, PIVKA-II) was recognized, too. We performed percutaneous transhepatic bile duct drainage (following PTBD) to decrease jaundice because abdominal echography and CT showed an extension of tumor thrombosis in bile duct and right hepatic duct by HCC of S8. However, a check of T-Bil. was 7.29 mg/dl and showed some slight decrease. Therefore, we administered prostaglandin E1 (following PGE1) at first with an intra-arterial injection catheter aiming to protect the hepatocyte. One week later, we performed hepatic artery injection chemotherapy (CDDP+5-FU) for four weeks. We confirmed a manifested improvement in T-Bil to be 1.92 mg/dl at the end of hepatic artery injections as well as a manifested decrease in hepatobiliary enzyme. We confirmed a decrease of HCC of S8 by abdominal CT, and the response rate was PR. Afterward the patient was conservatively treated even though pancytopenia was present, and was discharged from the hospital in June 2004. The hepatic artery injection chemotherapy used together with PGE1 was effective for the HCC patient with jaundice.
Uchida
Shinji
S
Dept. of Surgery, Kurume University School of Medicine.
Nokita
Hidefumi
H
Horiuchi
Hiroyuki
H
Hisaka
Toru
T
Ishikawa
Hiroto
H
Kawashima
Yuji
Y
Fujishita
Manami
M
Kinoshita
Hisafumi
H
Aoyagi
Shigeaki
S
Shirouzu
Kazuo
K
D000368:Aged; D000527:Alprostadil / Q000008:administration & dosage*; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001661:Biliary Tract Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007269:Injections, Intra-Arterial; D007565:Jaundice / Q000209:etiology*; D008113:Liver Neoplasms / Q000188:drug therapy*; D008297:Male
D000964:Antimetabolites, Antineoplastic; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D000527:Alprostadil; D005472:Fluorouracil