Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis.
OBJECTIVE
To evaluate the prognostic factors and efficacy of hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis.


METHODS
Fifty hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) were treated using hepatic arterial infusion chemotherapy (HAIC) via a subcutaneously implanted port. The epirubicin-cisplatin-5-fluorouracil (ECF) chemotherapeutic regimen consisted of 35 mg/m(2) epirubicin on day 1, 60 mg/m(2) cisplatin for 2 h on day 2, and 500 mg/m(2) 5-fluorouracil for 5 h on days 1-3. The treatments were repeated every 3 or 4 wk.


RESULTS
Three (6%) of the 50 patients achieved a complete response (CR), 13 (26%) showed partial responses (PR), and 22 (44%) had stable disease (SD). The median survival and time to progression were 7 and 2 mo, respectively. After 2 cycles of HAIC, CR was achieved in 1 patient (2%), PR in 10 patients (20%) and SD in 26 patients (52%). Significant pre-treatment prognostic factors were a tumor volume of < 400 cm(3) (P = 0.01) and normal levels of protein induced by vitamin K absence or antagonist (PIVKA)-II (P = 0.022). After 2 cycles of treatment, disease control (CR + PR + SD) (P = 0.001), PVTT response (P = 0.003) and α-fetoprotein reduction of over 50% (P = 0.02) were independent factors for survival. Objective response (CR + PR), disease control, PVTT response, and combination therapy during the HAIC were also significant prognostic factors. Adverse events were tolerable and successfully managed.


CONCLUSIONS
HAIC may be an effective treatment modality for advanced HCC with PVTT in patients with tumors < 400 cm(3) and good prognostic factors.
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea.
Do Seon
DS
Song
Si Hyun
SH
Bae
Myeong Jun
MJ
Song
Sung Won
SW
Lee
Hee Yeon
HY
Kim
Young Joon
YJ
Lee
Jung Suk
JS
Oh
Ho Jong
HJ
Chun
Hae Giu
HG
Lee
Jong Young
JY
Choi
Seung Kew
SK
Yoon
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016009:Chi-Square Distribution; D002945:Cisplatin / Q000008:administration & dosage; D018450:Disease Progression; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000098:blood supply / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011169:Portal Vein; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D020246:Venous Thrombosis / Q000150:complications*
D015251:Epirubicin; D002945:Cisplatin; D005472:Fluorouracil
Hepatic arterial infusion chemotherapy; Hepatocellular carcinoma; Portal vein tumor thrombosis