Brief Article
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World J Gastroenterol. Apr 28, 2012; 18(16): 1933-1939
Published online Apr 28, 2012. doi: 10.3748/wjg.v18.i16.1933
Is hepatic arterial infusion chemotherapy effective treatment for advanced hepatocellular carcinoma resistant to transarterial chemoembolization?
Hiroyuki Kirikoshi, Masato Yoneda, Hironori Mawatari, Koji Fujita, Kento Imajo, Shingo Kato, Kaori Suzuki, Noritoshi Kobayashi, Kensuke Kubota, Shin Maeda, Atsushi Nakajima, Satoru Saito
Hiroyuki Kirikoshi, Masato Yoneda, Hironori Mawatari, Koji Fujita, Kento Imajo, Shingo Kato, Kaori Suzuki, Noritoshi Kobayashi, Kensuke Kubota, Shin Maeda, Atsushi Nakajima, Satoru Saito, Gastroenterology Division, Yokohama City University Graduate School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama 236-0004, Japan
Author contributions: Kirikoshi H performed the literature review and drafted the manuscript, with contributions from Nakajima A and Saito S; Kirikoshi H, Saito S, Yoneda M, Mawatari H, Fujita K and Imajo K performed this combined therapy and follow up for this patients; Kato S, Suzuki K, Kobayashi N, Kubota K, and Maeda S collected the clinical data; all authors read and approved the final manuscript.
Supported by A Grant-in-Aid for research on the Third Term Comprehensive Control Research for Cancer from the Ministry on Health, Labour and Welfare, Japan, to Atsushi Nakajima; a grant from the National Institute of Biomedical Innovation (NBIO) to Atsushi Nakajima; a grant from the Ministry of Education, Culture, Sports, Science and Technology, Japan (KIBAN-B), to Atsushi Nakajima, (KIBAN-C), to Satoru Saito; the grant program, “Collaborative Development of Innovative Seeds,” from the Japan Science and Technology Agency (JST)
Correspondence to: Satoru Saito, Associate Professor, Gastroenterology Division, Yokohama City University Graduate School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama 236-0004, Japan. ssai1423@yokohama-cu.ac.jp
Telephone: +81-45-7872640 Fax: +81-45-7843546
Received: September 13, 2011
Revised: November 24, 2011
Accepted: February 27, 2012
Published online: April 28, 2012
Abstract

AIM: To evaluate the effectiveness of hepatic arterial infusion chemotherapy (HAIC) for advanced hepatocellular carcinoma (HCC) resistant to transarterial chemoembolization (TACE).

METHODS: This study was conducted on 42 patients who received HAIC for advanced HCC between 2001 and 2010 at our hospital. 5-fluorouracil (5-FU) was administered continuously for 24 h from day 1 to day 5 every 2-4 wk via an injection reservoir. Intra-arterial cisplatin or subcutaneous interferon was administered in combination with the 5-FU. The patients enrolled in this retrospective study were divided into two groups according to whether or not they fulfilled the criteria for resistance to TACE proposed by the Japan Society of Hepatology in 2010 (written in Japanese); one group of patients who did not fulfill the criteria for TACE resistance (group A, n = 23), and another group who fulfilled the criteria for TACE resistance (group B, n = 19). We compared the outcomes in terms of the response and survival rates between the two groups.

RESULTS: Both the response rate and tumor suppression rate following HAIC were significantly superior in group A than in group B (response rate: 48% vs 16%, P = 0.028, tumor suppression rate: 87% vs 53%, P = 0.014). Furthermore, both the progression-free survival rate and survival time were significantly superior in group A than in group B (3-, 6-, 12-, and 24-mo = 83%, 70%, 29% and 20% vs 63%, 42%, 16% and 0%, respectively, P = 0.040, and 9.8 mo vs 6.2 mo, P = 0.040). A multivariate analysis (Cox proportional hazards regression model) showed that resistance to TACE was an independent predictor of poor survival (P = 0.007).

CONCLUSION: HAIC administrating 5-FU was not effective against advanced HCC resistant to TACE. Other tools for treatment, i.e., molecular-targeting agents may be considered for these cases.

Keywords: Hepatocellular carcinoma; Hepatic arterial infusion chemotherapy; 5-fluorouracil; Transarterial chemoembolization