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A combination therapy with transarterial chemo-lipiodolization and systemic chemo-infusion for large extensive hepatocellular carcinoma invading portal vein in comparison with conservative management

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Abstract

Purpose: Hepatocellular carcinoma (HCC) invading the portal vein is a medical challenge. We evaluated the therapeutic efficacy of a combination of transarterial and systemic chemo-infusion for large HCC with portal vein thrombosis (PVT) compared with conservative management. Patients and methods: This was a case-control cohort study of 103 consecutive patients with Child-Pugh class A who had a large (>10 cm) HCC with PVT. The patients were assigned to receive either combined transarterial epirubicin (50 mg/m2) plus cisplatin (60 mg/m2) chemo-lipiodolization and systemic 5-fluorouracil (200 mg/m2) chemo-infusion (ECF regimen) at monthly intervals (n=80) or conservative management (n=23). Results: The objective tumor response (21.3 vs. 0%, P=0.011) and overall survival (8.7 vs. 3.5 months, P<0.001) were significantly better in the treatment group than in the conservative group. The prognostic factors for survival were tumor type (P=0.007), bilobar involvement (P=0.001), distant metastasis (P=0.009) and objective tumor response (P<0.001) for the treatment group. Survival benefits with the treatment were also maintained in each subgroup after stratification of these variables. Conclusions: This study suggests that when the hepatic function is preserved, a therapeutic strategy could be more beneficial than conservative management for such a large extensive HCC. As a therapeutic option, a combination therapy using ECF regimen may provide a significantly better tumor response and survival benefit in patients with large HCC invading the portal vein.

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Authors and Affiliations

  1. Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, #505 Banpodong, Seocho-ku, 137-040, Seoul, South Korea

    Jeong Won Jang, Si Hyun Bae, Jong Young Choi, Hyun Jong Oh, Min Soo Kim, So Yeon Lee, Chang Wook Kim, U Im Chang, Soon Woo Nam, Sang Bok Cha & Seung Kew Yoon

  2. Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Young Joon Lee, Ho Jong Chun, Byung Gil Choi & Jae Young Byun

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  1. Jeong Won Jang
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  2. Si Hyun Bae
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  4. Hyun Jong Oh
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  5. Min Soo Kim
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  7. Chang Wook Kim
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  8. U Im Chang
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  13. Byung Gil Choi
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  15. Seung Kew Yoon
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Correspondence to Seung Kew Yoon.

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Jang, J.W., Bae, S.H., Choi, J.Y. et al. A combination therapy with transarterial chemo-lipiodolization and systemic chemo-infusion for large extensive hepatocellular carcinoma invading portal vein in comparison with conservative management. Cancer Chemother Pharmacol 59, 9–15 (2007). https://doi.org/10.1007/s00280-006-0239-0

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  • DOI: https://doi.org/10.1007/s00280-006-0239-0

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