Hepatic arterial infusion of 5‐fluorouracil and cisplatin for unresectable or recurrent hepatocellular carcinoma with tumor thrombus of the portal vein

Itamoto, Toshiyuki; Nakahara, Hiroyuki; Tashiro, Hirotaka; Haruta, Naoki; Asahara, Toshimasa; Naito, Akira; Ito, Katsuhide

doi:10.1002/jso.10116

Cited by 62 publications

(59 citation statements)

References 17 publications

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“…Recently, some authors reported that even patients with liver cirrhosis were treated effectively with TAI (cisplatin and 5-fluorouracil). 10,11 Moreover, interferon ␣ was added to TAI to augment the cytotoxic effects. 32,33 In those studies, the objective response rates were 33-73%; the overall survival rates at 1 years and 2 years were 24 -45% and 15-31%, respectively; and the median survival was 7.5-10.2 months.…”

Section: Discussionmentioning

confidence: 99%

“…6,10,11,32,33,[42][43][44][45] Furthermore, 75% of the patients in the current series had bulky tumors that measured Ն 50 mm in greatest dimension. This result suggests that proton beam therapy alone can be a curative modality of treatment for patients who have HCC with PVTT.…”

Section: Discussionmentioning

confidence: 99%

“…6,10,11,29,[31][32][33][42][43][44][45] Five of 12 patients survived for Ͼ 4 years after treatment, and, 3 patients remain alive without disease. To our knowledge, this is the first report to present excellent survival for patients who had HCC with PVTT.…”

Section: Discussionmentioning

confidence: 99%

“…There were none of the uncomfortable symptoms, such as fever or emesis, or mortal complications, such as sepsis or gastrointestinal bleeding, that were observed in the other treatment modalities (TAI, TACE, and radiation therapy with photons). 6,10,11,32,33,[42][43][44][45] In conclusion, proton beam therapy was feasible and effective for the treatment of patients who had HCC with PVTT, and it appeared to improve survival and local control significantly. A prospective study for patients with HCC who have PVTT to define the role of proton beam therapy further is proceeding at our new facility.…”

Section: Discussionmentioning

confidence: 99%

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Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

Hata

Tokuuye

Sugahara

et al. 2005

Cancer

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BACKGROUNDTreatment modalities for patients with hepatocellular carcinoma (HCC) who have portal vein tumor thrombus (PVTT) are limited and controversial; furthermore, the prognosis for these patients is extremely poor. The authors conducted a retrospective review to determine the role of proton beam therapy in the treatment of patients who had HCC with PVTT.METHODSTwelve patients with HCC who had tumor thrombus in the main trunk or major branches of the portal vein (clinical T3–T4N0M0) were treated with proton beam therapy. At the time they received proton beam irradiation, patients ranged in age from 42 years to 80 years (median, 62 years), and their tumors ranged in size from 40 mm to 110 mm (median, 60 mm) in greatest dimension. A total dose of 50–72 gray (Gy) (median, 55 Gy) in 10–22 fractions was delivered to the tumors, including PVTT.RESULTSAll tumors that were treated with proton beam therapy remained controlled at a median follow‐up of 2.3 years (range, 0.3–7.3 years). Among 12 patients, 10 patients had new liver tumors outside the irradiated volume 0.1–2.4 years after proton beam therapy, and 3 patients also had distant metastases; consequently, 8 patients died of disease, and 2 patients were salvaged by further therapies. The remaining two patients were alive with no evidence of disease 4.3 years and 6.4 years after proton beam therapy. The progression‐free survival rates were 67% at 2 years and 24% at 5 years. The median progression‐free survival was 2.3 years. According to the Acute Radiation Morbidity Scoring Criteria (Radiation Therapy Oncology Group), therapy‐related toxicity ≥ Grade 3 was not observed.CONCLUSIONSProton beam therapy for patients with HCC who had PVTT was feasible and effective. It appeared to improve survival and local control significantly for these patients. Cancer 2005. © 2005 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

Hata

Tokuuye

Sugahara

et al. 2005

Cancer

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“…HAIC appears to deliver high concentrations of chemotherapeutic agents to HCC tissues selectively, with low toxicity for non-cancerous liver tissues and the whole body. Several reports described the effects of HAIC with cisplatin and 5-FU or systemic interferon-α therapy with HAIC using 5-FU for HCC patients with tumor thrombosis in the first branches and the portal vein trunks (21,45). Therefore, we showed that NFP is more effective than sorafenib therapy in patients with advanced HCC and MVI.…”

Section: Discussionmentioning

confidence: 58%

Clinical effects and safety of intra‑arterial infusion therapy of cisplatin suspension in lipiodol combined with 5‑fluorouracil versus sorafenib, for advanced hepatocellular carcinoma with macroscopic vascular invasion without extra‑hepatic spread: A prospective cohort study

Nakano

Nishizaki

Nagamatsu³

et al. 2017

mol clin onc

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Abstract. Although sorafenib and hepatic arterial infusion chemotherapy (HAIC) have been proven to improve prognosis in hepatocellular carcinoma (HCC) patients with macroscopic vascular invasion (MVI), the most appropriate approach remains unclear. The present multicenter, non-randomized, prospective cohort study aimed to compare the efficacy and safety of HAIC and sorafenib in patients with advanced HCC and MVI, without extra-hepatic spread (EHS) and Child-Pugh class A disease. The present study was performed between April 2008 and March 2014, and 64 HCC patients with MVI, without EHS and Child-Pugh class A disease were registered. Of these patients, 44 were treated with HAIC and 20 with sorafenib. HAIC involved cisplatin (50 mg fine powder in 5-10 ml lipiodol) and a continuous infusion of 5-fluorouracil (FU) (1,500 mg/5 days), which is referred to as new 5-FU and cisplatin therapy (NFP). The primary outcome was progression-free survival, and the secondary outcome was overall survival (OS). Clinical factors influencing OS and the therapeutic effect were identified using univariate and multivariate analyses. There were no differences in clinical factors between the two groups. The median progression-free survival was 5.1 and 9.5 months in the sorafenib and NFP groups, respectively (P=0.001). The complete response (CR) or partial response (PR) rates were 10 and 71% in the sorafenib and NFP groups, respectively (P<0.001). The median OS in the sorafenib and NFP groups was 13.2 and 30.4 months, respectively (P=0.013). Multivariate analysis revealed that the independent predictors of survival were Child-Pugh score (5, P=0.022, 95% CI,, grade of portal vein invasion (brunch, P=0.009, 95% CI, 0.220-0.752), and therapeutic effect (CR or PR, P<0.001, 95% CI, 0.220-0.752), and the independent predictor of therapeutic effect was therapeutic regimen (NFP, P<0.001, 95% CI,. NFP should be the first choice for patients with advanced HCC and MVI, without EHS and Child-Pugh A disease.

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Chemotherapeutic perfusion of portal vein after tumor thrombectomy and hepatectomy benefits patients with advanced hepatocellular carcinoma: A propensity score‐matched survival analysis

et al. 2019

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Background Portal vein tumor thrombus (PVTT) is a common complication in hepatocellular carcinoma (HCC), signaling dismal outcomes. This study was conducted to evaluate the survival benefit of postoperative portal vein perfusion chemotherapy (PVC) in patients with HCC and PVTT. Methods A retrospective review was conducted in 401 consecutive patients with HCC and PVTT who underwent hepatic resection between January 2009 and December 2015 and 67 patients received adjuvant postoperative PVC. A propensity score matching (PSM) was used to match patients with and without PVC at a ratio of 1:1. Results After PSM, the median time to recurrence (TTR) and overall survival (OS) were significantly longer in PVC group compared with control group (12.3 vs 5.8 months, P = .001; 19.0 vs 13.4 months, P = .037; respectively). At 1, 2, 3, and 5 years, the cumulative recurrence rates in PVC group were 48.1%, 86.5%, 92.3% ,96.2%, respectively, with OS rates of 63.8%, 37.9%, 24.4%, 18.3%, respectively; whereas cumulative recurrence rates of 76.6%, 91.5%, 94.3%, and 97.2%, respectively and OS rates of 55.4%, 23.0%, 12.4%, and 12.4%, respectively were recorded for the control group. In multivariate analysis, postoperative PVC emerged as a significant predictor for TTR (hazard ratio [HR], 0.523; P = .001) and OS (HR, 0.591; P = .010). PVC could reduce early recurrence (≤1 year) rate after surgical resection (40.3% vs 64.2%, P = .006) and clinical outcomes were further enhanced by adding sorafenib to postoperative PVC. Conclusions Compared with surgical resection alone, postoperative adjuvant PVC treatment boosts survival and reduces early tumor recurrences in patients surgically treated for HCC and PVTT.

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Hepatic arterial infusion of 5‐fluorouracil and cisplatin for unresectable or recurrent hepatocellular carcinoma with tumor thrombus of the portal vein

Abstract: The chemotherapy described in this report is beneficial in terms of survival for HCC patients with PVTT for whom transcatheter arterial embolization or surgical treatment is contraindicated.

Cited by 62 publications

References 17 publications

Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

Clinical effects and safety of intra‑arterial infusion therapy of cisplatin suspension in lipiodol combined with 5‑fluorouracil versus sorafenib, for advanced hepatocellular carcinoma with macroscopic vascular invasion without extra‑hepatic spread: A prospective cohort study

Chemotherapeutic perfusion of portal vein after tumor thrombectomy and hepatectomy benefits patients with advanced hepatocellular carcinoma: A propensity score‐matched survival analysis

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