Superselective intra-arterial chemotherapy with mitomycin C for hepatocellular carcinoma

Thirty-six patients with primary hepatocellular carcinoma were treated by superselective intra-arterial chemotherapy with mitomycin C (SIAC) between 1981 and 1990, either as primary chemotherapy without operation (28) or as additional therapy after resective surgery (8). During the same period 10 patients were resected radically and 26 patients treated conservatively. The overall response rate to SIAC was 25% (9/36), comprising two complete and seven partial responses. The cumulative 5-year survival rate was significantly related to the percentage of hepatic replacement (PHR) (P < 0.01) and to resective surgery (P < 0.01). Overall 5-year survival was only 4% and all the patients with PHR over 75% died within 2 or 3 years. Cessation of chemotherapy was necessary in 72% of cases (26/36), because of tumour progression in 20 cases, chemotherapy toxicity in four and one technical error in one and patient refusal in one. The results of the use of SIAC as a chemotherapeutic agent for hepatocellular cancer may be regarded as disappointing, as the response rate remained low and the medication was unable to prevent tumour progression in most cases. We intend to use SIAC only for stage I-II tumours and as additional therapy after surgery when the radicality remains uncertain.