Hepatic arterial infusion chemotherapy for hepatocellular carcinoma with portal vein tumor thrombosis

Abstract

Aim: Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is associated with poor prognosis. The aim of this prospective study was to evaluate the efficacy of hepatic arterial infusion chemotherapy (HAIC) for patients with this disease.

Methods: Eighteen HCC patients with PVTT were treated with HAIC via a subcutaneously implanted injection port. A course of chemotherapy consisted of daily cisplatin (10 mg for one hour) followed by 5-fluorouracil (250 mg for five hours) for five continuous days within a given week. The patients were scheduled to receive four consecutive courses of HAIC. Responders were defined in whom either a complete or partial response was achieved, while non-responders were defined based on stable or progressive disease status. The prognostic factors associated with survival after treatment were analyzed.

Results: Six patients exhibited partial response to this form of HAIC (response rate=33%). The 3, 6, 9, 12 and 18-month cumulative survival rates for the 18 patients were 83%, 72%, 50%, 28%, and 7%, respectively. Median survival times for the six responders and 12 non-responders were 15.0 (range, 11-18) and 7.5 (range, 1-13) months, respectively. It was demonstrated by both univariate and multivariate analyses that the therapeutic response and hepatic reserve function were significant prognostic factors.

Conclusion: HAIC using low-dose cisplatin and 5-fluorouracil may be a useful alternative for the treatment of patients with advanced HCC complicated with PVTT. There may also be survival-related benefits associated with HAIC.

Figure 1

Cumulative survival for 18 hepatocellular carcinoma patients with portal vein tumor thrombosis undergoing hepatic arterial infusion chemotherapy. The 3, 6, 9, 12, 15 and 18-month cumulative survival rates for the 18 patients were 83%, 72%, 50%, 28%, 14%, and 7%, respectively.

Figure 2

Image study using abdominal computed tomogra-phy (hepatic artery phase) of an HCC patient with good partial response to hepatic arterial infusion chemotherapy (HAIC) shows a marked decrease in tumor size from 14 × 10 × 9 cm (A: before HAIC) to 9 × 8 × 7 cm (B: 1.5 months after initiation of HAIC) and 5 × 5 × 3 cm (C: 4 months after initiation of HAIC).