Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 14, 2012; 18(26): 3426-3434
Published online Jul 14, 2012. doi: 10.3748/wjg.v18.i26.3426
Efficacy of hepatic arterial infusion chemotherapy in advanced hepatocellular carcinoma
Yang Hyun Baek, Kyoung Tae Kim, Sung Wook Lee, Jin Sook Jeong, Byeong Ho Park, Kyung Jin Nam, Jin Han Cho, Young Hoon Kim, Young Hoon Roh, Hyung Sik Lee, Young Min Choi, Sang Young Han
Yang Hyun Baek, Kyoung Tae Kim, Sung Wook Lee, Sang Young Han, Department of Internal Medicine, Dong-A University College of Medicine, Busan 602-103, South Korea
Jin Sook Jeong, Department of Pathology, Dong-A University College of Medicine, Busan 602-103, South Korea
Byeong Ho Park, Kyung Jin Nam, Jin Han Cho, Department of Radiology, Dong-A University College of Medicine, Busan 602-103, South Korea
Young Hoon Kim, Young Hoon Roh, Department of Surgery, Dong-A University College of Medicine, Busan 602-103, South Korea
Hyung Sik Lee, Young Min Choi, Department of Radiation Oncology, Dong-A University College of Medicine, Busan 602-103, South Korea
Author contributions: Baek YH, Kim KT, Lee SW and Han SY designed the research; Baek YH, Kim KT and Han SY performed the research; Park BH, Nam KJ and Cho JH performed technical procedures; Kim YH, Lee HS and Choi YM contributed analytic tools; Baek YH, Jeong JS and Roh YH analyzed the data; and Baek YH and Kim KT wrote the paper.
Supported by Dong-A University
Correspondence to: Sang Young Han, Head Professor, Department of Internal Medicine, Dong-A University College of Medicine, 3-ga Dongdaisin-dong, Seo-gu Busan 602-103, South Korea. syhan@dau.ac.kr
Telephone: +82-51-2405627 Fax: +82-51-2402087
Received: October 26, 2011
Revised: February 20, 2012
Accepted: February 26, 2012
Published online: July 14, 2012
Abstract

AIM: To investigate the efficacy of hepatic arterial infusion chemotherapy (HAIC) using floxuridine (FUDR) in patients with advanced hepatocellular carcinoma (HCC) confined to the liver.

METHODS: Thirty-four patients who had advanced HCC with unresectability or unsuccessful previous therapy in the absence of extrahepatic metastasis were treated with intra-arterial FUDR chemotherapy at our hospital between March 2005 and May 2008. Among the 34 patients, 9 patients were classified as Child class C, and 18 patients had portal vein tumor thrombus (PVTT). One course of chemotherapy consisted of continuous infusion of FUDR (0.3 mg/kg during day 1-14) and dexamethasone (10 mg on day 1, 4, 7 and 11), and this treatment was repeated every 28 d.

RESULTS: Two patients (5.9%) displayed a complete response, and 12 patients (35.3%) had a partial response. The tumor control rate was 61.8%. The median overall survival times were 15.3 mo, 12.4 mo and 4.3 mo for the patients who were classified as Child class A, Child class B and Child class C, respectively (P = 0.0392). The progression-free survival was 12.9 mo, 7.7 mo and 2.6 mo for the patients who were classified as Child class A, Child class B and Child class C, respectively (P = 0.0443). The cumulative survival differed significantly according to the Child-Pugh classification and the presence of PVTT. In addition to hepatic reserve capacity and PVTT, the extent of HCC was an independent factor in determining a poor prognosis. The most common adverse reactions to HAIC were mucositis, diarrhea and peptic ulcer disease, but most of these complications were improved by medical treatment and/or a delay of HAIC.

CONCLUSION: The present study demonstrates that intra-arterial FUDR chemotherapy is a safe and effective treatment for advanced HCC that is recalcitrant to other therapeutic modalities, even in patients with advanced cirrhosis.

Keywords: Hepatic arterial infusion chemotherapy, Floxuridine, Advanced hepatocellular carcinoma, Child-Pugh classification, Portal vein tumor thrombus