New hope in irresectable hepatoma?

Primary hepatocellular carcinoma (HCC) is mostly irresectable and the survival time is short. Treatment can be palliative but hardly improves survival. Some promising future aspects that should be considered include continuous intra-hepatic chemotherapy (fraught with difficulties but nevertheless worth pursuing), direct percutaneous injection of alcohol into the tumor tissue under ultrasound guidance, as well as cryotherapy of "occult" tumors. Monoclonal technique may help to target toxic therapy to the tumors whereas monoclonal antibodies raised in humans may possibly obviate the imminent dangers of antibody formation that would be an obstacle. Although all this may still smack a little of "Zukunftsmusik" ("music of the future") that would require considerable perseverance and effort before it could be translated into reality, every avenue must of course be explored. Chemical techniques that give rise to new hopes feature radio-labelled lipids selectively retained in foci of hepatocellular carcinomas; research has already gone into the question of retention within the tumor microvasculature, within the extracellular space, and the uptake by tumor cells. The oily anticancer agent SMANCS has already been combined with ethiodol (Lipiodol), an iodine addition product of the ethyl esters of saturated and unsaturated fatty acids, and selectively infused, resulting in a reduction in tumor size, and the survival time also seems to be improved following the use of Lipiodol combined with SMANCS or with other cytotoxic agents. After an encouraging pilot study, we treated 16 patients suffering from HCC, with a combination of Lipiodol and epirubicin, a cytotoxic agent having an enhanced activity against HCC as compared with its parent drug doxorubicin.(ABSTRACT TRUNCATED AT 250 WORDS)