title: Debulking surgery followed by intraarterial 5-fluorouracil chemotherapy plus subcutaneous interferon alfa for massive hepatocellular carcinoma with multiple intrahepatic metastases: a pilot study.
abstract: BACKGROUND
  The prognosis in advanced hepatocellular carcinoma (HCC) with multiple intrahepatic metastases is extremely poor. Combination therapy with subcutaneous interferon (IFN) alfa and intraarterial 5-fluorouracil was reported to be effective against such advanced HCC. We describe results of debulking surgery followed by combination therapy with IFN alfa and 5-FU for massive HCC with multiple intrahepatic metastases.
  
  
  METHODS
  In 27 HCC patients with massive tumors and multiple intrahepatic metastases, we performed combination therapy with IFN alfa and 5-FU after maximal liver tumor resection.
  
  
  RESULTS
  Mean patient age was 63.3 years. Including intrahepatic metastases, tumors numbered 5 or more in 17 patients (63%). Portal or hepatic vein branches were invaded in 22 (81%). The mean maximum tumor diameter was 102 mm. Among 24 patients whose results were analyzed, an objective response by residual intrahepatic metastases was observed in 13 (54%; complete response in 12, and partial response in 1). Overall 1-, 3-, and 5-year survival was 73.2%, 38.7%, and 38.7%, respectively; 1-, 3-, and 5-year progression-free rates were 38.2%, 22.3%, and 22.3%.
  
  
  CONCLUSIONS
  Debulking surgery followed by IFN alfa and 5-FU combination chemotherapy offers possibility of long-term survival despite massive HCC with multiple intrahepatic metastases.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. Electronic address: ktrj112@urahp.yokohama-cu.ac.jp.
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: Y
authors.initials: Y
authors.lastname: Yabushita
authors.forename: K
authors.initials: K
authors.lastname: Nakagawa
authors.forename: T
authors.initials: T
authors.lastname: Kumamoto
authors.forename: K
authors.initials: K
authors.lastname: Matsuo
authors.forename: M
authors.initials: M
authors.lastname: Taguri
authors.forename: I
authors.initials: I
authors.lastname: Endo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006498:Hepatectomy; D006801:Humans; D007261:Infusions, Intra-Arterial; D007279:Injections, Subcutaneous; D016898:Interferon-alpha / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010865:Pilot Projects; D016016:Proportional Hazards Models; D015996:Survival Rate; D047368:Tumor Burden
chemical_list: D016898:Interferon-alpha; D005472:Fluorouracil
keywords: 95% confidence interval; AFP; CDDP; CH; CI; CT; CT with arterioportography; CTAP; CTx; ECOG; Eastern Cooperative Oncology Group; FU; GI; HBV; HCC; HCV; Hepatocellular carcinoma; Hx; ICGR15; IFN; Intraarterial chemotherapy; LC; NBNC; NL; PIVKA; PS; RR; Reduction surgery; Survival; TACE; US; chemotherapy; chronic hepatitis; cisplatin; computed tomography; fluorouracil; gastrointestinal; hepatectomy; hepatitis B virus; hepatitis C virus; hepatocellular carcinoma; indocyanine green retention rate at 15 min; interferon; liver cirrhosis; non-B viral, non-C viral; normal liver; prediction score; protein induced by vitamin K absence; relative risk; transcatheter arterial chemoembolization; ultrasonography; α-fetoprotein