Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 3970-3977
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3970
Oxaliplatin and 5-fluorouracil hepatic infusion with lipiodolized chemoembolization in large hepatocellular carcinoma
Jing-Huan Li, Xiao-Ying Xie, Lan Zhang, Fan Le, Ning-Ling Ge, Li-Xin Li, Yu-Hong Gan, Yi Chen, Ju-Bo Zhang, Tong-Chun Xue, Rong-Xin Chen, Jing-Lin Xia, Bo-Heng Zhang, Sheng-Long Ye, Yan-Hong Wang, Zheng-Gang Ren
Jing-Huan Li, Xiao-Ying Xie, Lan Zhang, Fan Le, Ning-Ling Ge, Li-Xin Li, Yu-Hong Gan, Yi Chen, Ju-Bo Zhang, Tong-Chun Xue, Rong-Xin Chen, Jing-Lin Xia, Bo-Heng Zhang, Sheng-Long Ye, Yan-Hong Wang, Zheng-Gang Ren, Key Laboratory of Carcinogenesis and Cancer Invasion, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Ministry of Education, Shanghai 200032, China
Author contributions: Li JH and Xie XY equally contributed to this paper; Wang YH and Ren ZG designed the research; Li JH, Xie XY, Zhang L, Le F, Ge NL, Li LX, Gan YH, Chen Y, Zhang JB, Xue TC, Chen RX, Xia JL, Zhang BH, Ye SL, Wang YH, and Ren ZG contributed to collection of the clinical data; Li JH, Xie XY and Ren ZG wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zheng-Gang Ren, PhD, M.D., Key Laboratory of Carcinogenesis and Cancer Invasion, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Ministry of Education, 180 Fenglin Road, Shanghai 200032, China. renzhenggang@hotmail.com
Telephone: +86-21-64041990 Fax: +86-21-64037181
Received: September 3, 2014
Peer-review started: September 4, 2014
First decision: October 14, 2014
Revised: November 2, 2014
Accepted: December 5, 2014
Article in press: December 8, 2014
Published online: April 7, 2015
Abstract

AIM: To investigate transarterial chemoembolization (TACE) with hepatic infusion of oxaliplatin and 5-fluorouracil and Lipiodol chemoembolization in large hepatocellular carcinoma (HCC).

METHODS: In this retrospective study, 132 patients with unresectable HCCs larger than 10 cm were treated with hepatic infusion of oxaliplatin and 5-fluorouracil followed by Lipiodol chemoembolization. The primary endpoint was overall survival (OS). Sixteen-week disease-control rate, time to progression (TTP), and major complications were also studied. Univariate and multivariate analyses were performed to identify prognostic factors affecting OS and TTP.

RESULTS: A total of 319 procedures were performed in the 132 patients. Eleven (8.3%) patients received radical resection following TACE treatment (median time to initial TACE 4.3 ± 2.3 mo). The median OS and TTP were 10.3 and 3.0 mo respectively, with a 50.0% 16-wk disease-control rate. Major complications were encountered in 6.0% (8/132) of patients following TACE and included serious jaundice in 1.5% (2/132) patients, aleukia in 1.5% (2/132), and hepatic failure in 3.0% (4/132). One patient died within one month due to serious hepatic failure and severe sepsis after receiving the second TACE. The risk factor associated with TTP was baseline alpha-fetoprotein level, and vascular invasion was an independent factor related to OS.

CONCLUSION: Hepatic infusion of oxaliplatin and 5-fluorouracil followed by lipiodolized-chemoembolization is a safe and promising treatment for patients with HCCs larger than 10 cm in diameter.

Keywords: Hepatic infusion, Large hepatocellular carcinoma, Oxaliplatin, Transarterial chemoembolization, 5-fluorouracil

Core tip: Treatment of large unresectable hepatocellular carcinomas (HCCs) with diameters exceeding 10 cm is clinically challenging due to the low response rate and high rate of major complications. In this study, the safety and efficacy of a transarterial chemoembolization modality that included a combination of oxaliplatin and 5-fluorourcil infusion followed by embolization with a mixture of mitomycin and Lipiodol was tested in patients with large HCCs. The results indicate that this modality is a promising treatment for certain patients with large HCCs.