[Recent progress in multidisciplinary treatment of hepatic cancer]

Fifteen to 20 years ago, the natural history of HCC demonstrated approximately 1.5 months median survival after diagnosis with rare cases of one-year survival. Ten to 15 years ago, one shot intraarterial (IA) injection of mitomycin C (MMC) or doxorubicin (ADR) became the prevailing treatment and prolonged median survival to 3-5 months. Ten years ago, transcatheter arterial embolization was introduced and improved the survival rate dramatically. In the earlier period, TAE was performed with gelatin sponge (GS) plus ADR or MMC and showed shrinkage of HCC in the well-capsulated case. Combined use of Lipiodol (LPD) with anticancer drug and GS in later period showed further progress in antitumor response and survival. The one year survival rate obtained from our 100 cases was 53.8%, and the 2 year one was 36.5%. We speculate that the effective response of LPD plus drug to intrahepatic daughter nodules contributed to this improvement because we clarified the efflux of LPD to peripheral portal vein clinically and experimentally. Since the metastatic liver tumor originating from colon or gastric cancer is usually hypovascular and shows limited response to intra-arterial chemotherapy, a special device is needed for improvement. We introduced an S.C. implanted port for injection route and long-term intermittent IA combination therapy with ADR or MMC and degradable starch microspheres (DSM), which embolise arteries temporarily for 20-30 minutes. These new methods achieved a favorable response rate with better quality of life, and would be expected to prolong the life span of patients with metastatic liver tumor.