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

Abstract

Aim: 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.

Conclusion: HAIC may be an effective treatment modality for advanced HCC with PVTT in patients with tumors < 400 cm(3) and good prognostic factors.

Keywords: Hepatic arterial infusion chemotherapy; Hepatocellular carcinoma; Portal vein tumor thrombosis.

Figure 1

Overall survival rate (A) and time to disease progression (B) of the patients. OS: Overall survival; TTP: Time to disease progression.

Figure 2

Overall survival of the objective response and disease control groups. A, B: After the second cycle of high-dose hepatic arterial infusion chemotherapy (HAIC); C, D: During HAIC.

Figure 3

Cumulative survival rate according to the presence of extrahepatic metastasis.

Figure 4

Cumulative survival rates. A: According to the pre-treatment α-fetoprotein (AFP) level; B: According to the AFP reduction after two cycles of hepatic arterial infusion chemotherapy (HAIC); C: According to the pre-treatment protein induced by vitamin K absence or antagonist (PIVKA)-II level; D: According to the PIVKA-II reduction after two cycles of HAIC.