Original Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 7, 2013; 19(29): 4679-4688
Published online Aug 7, 2013. doi: 10.3748/wjg.v19.i29.4679
Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis
Do Seon Song, Si Hyun Bae, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Young Joon Lee, Jung Suk Oh, Ho Jong Chun, Hae Giu Lee, Jong Young Choi, Seung Kew Yoon
Do Seon Song, Si Hyun Bae, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea
Young Joon Lee, Jung Suk Oh, Ho Jong Chun, Hae Giu Lee, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea
Author contributions: All the authors contributed equally to this manuscript.
Supported by National R and D Program Grant for Cancer Control from the Ministry of Health, Welfare and Family Affairs, Republic of Korea (R0620390-1)
Correspondence to: Si Hyun Bae, MD, PhD, Professor, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul 137-040, South Korea. baesh@catholic.ac.kr
Telephone: +82-2-22582073 Fax: +82-2-34814025
Received: March 29, 2013
Revised: June 2, 2013
Accepted: June 8, 2013
Published online: August 7, 2013
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/m2 epirubicin on day 1, 60 mg/m2 cisplatin for 2 h on day 2, and 500 mg/m2 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 cm3 (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 cm3 and good prognostic factors.

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

Core tip: The aim of this study was to investigate the prognostic factors of hepatic arterial infusion chemotherapy in advanced hepatocellular carcinoma patients with portal vein tumor thrombosis. The primary findings of this study were as follows: (1) The median survival and time to progression were 7 and 2 mo, respectively; (2) A tumor volume of < 400 cm3 and protein induced by vitamin K absence or antagonist-II were independent pre-treatment prognostic factors; (3) Disease control and ≥ 50% tumor marker reduction were significant prognostic factors after the second cycle of hepatic arterial infusion chemotherapy (HAIC); and (4) Objective tumor response, disease control and portal vein tumor thrombosis response were independent post-treatment prognostic factors at the end of the HAIC.