title: Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma with Portal Vein Thrombosis: Impact of Early Response to 4 Weeks of Treatment.
abstract: OBJECTIVE
  The aim of the study was to investigate the impact of early response (ER) to hepatic arterial infusion chemotherapy (HAIC) on outcomes of patients with advanced hepatocellular carcinoma (HCC) complicated with major portal vein tumor thrombosis (PVTT).
  
  
  METHODS
  Thirty-nine patients receiving HAIC with low-dose cisplatin, 5-fluorouracil (5FU), and leucovorin were enrolled. One course of HAIC consisted of 5 days of treatment and 2 days rest per week for 4 consecutive weeks. ER was categorized as complete response, partial response, or minor response and was determined by World Health Organization criteria with dynamic computed tomography findings performed within 1 week after the first course of HAIC.
  
  
  RESULTS
  Thirteen (33%) patients achieved an ER. Twelve (92.3%) of these 13 ER patients achieved a higher overall response than all but one (3.8%) of the 26 non-early responders (NERs) (p<0.001). ER was the exclusive independent favorable factor for survival (p=0.003). Downstaging of tumors was noted in 76.9% of ERs, and these patients could proceed to locoregional therapies. ER patients subsequently had a higher 1-year survival (76.9% vs. 3.8%, p<0.001) and 6-month progression-free survival (PFS) (84.6% vs. 15.4%, p<0.001) than those for NERs. Only 8% of patients experienced grade 3 or higher toxicity during the first 4-week course of HAIC.
  
  
  CONCLUSIONS
  HAIC can yield a satisfactory ER for advanced HCC with PVTT. Moreover, achievement of ER after HAIC in advanced HCC with PVTT is strongly associated with better overall survival and PFS.
authors.affiliation: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan (ROC).
authors.forename: Chen-Chun
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Division of Diagnostic Radiology and Department of Radiology, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan (ROC).
authors.forename: Chien-Fu
authors.initials: CF
authors.lastname: Hung
authors.affiliation: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan (ROC).
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan (ROC).
authors.forename: Shi-Ming
authors.initials: SM
authors.lastname: Lin
keywords: Early response; Hepatic arterial infusion chemotherapy; Hepatocellular carcinoma; Overall survival; Portal vein thrombosis; Progression-free survival