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[The long-term results of percutaneous isolated hepatic perfusion for patients with advanced hepatocellular
1First Dept. of Surgery, Faculty of Medicine, Kobe University.
Insights
Percutaneous isolated hepatic perfusion (PIHP) offers long-term remission for advanced hepatocellular carcinoma patients. This treatment achieved a 5-year survival rate of 40% in select patients with extensive liver tumors.
Area of Science:
- Hepatobiliary Surgery
- Interventional Oncology
- Medical Oncology
Context:
- Hepatocellular carcinoma (HCC) presents significant treatment challenges, especially in advanced stages.
- Percutaneous isolated hepatic perfusion (PIHP) is an innovative regional chemotherapy delivery method.
- Evaluating the long-term efficacy of PIHP in advanced HCC is crucial for treatment planning.
Purpose:
- To assess the long-term outcomes of percutaneous isolated hepatic perfusion (PIHP) in patients with advanced hepatocellular carcinoma (HCC).
- To determine the survival rates and response to PIHP in patients with Stage IVA and IVB HCC, including those with vascular invasion and multiple metastases.
Summary:
- This study evaluated 36 patients with advanced HCC (Stage IVA/IVB) treated with PIHP using adriamycin or cisplatin.
- The overall response rate was 59%, with 6 complete responses (CR) and 13 partial responses (PR).
- Five-year survival rates were 36% for Stage IVA and 0% for Stage IVB, with rates decreasing in cases of vascular invasion.
Impact:
- PIHP demonstrated a 5-year survival rate of approximately 40% in selected advanced HCC patients without distant metastases.
- Complete long-term remission was achieved in a subset of patients, highlighting PIHP's potential in managing complex HCC cases.
- The findings suggest PIHP can be a valuable option for advanced HCC, particularly in patients with multiple intrahepatic metastases and specific vascular invasion profiles.
Abstract:
We studied the long-term outcome of percutaneous isolated hepatic perfusion (PIHP) for patients with hepatocellular carcinoma. This study included 31 patients with Stage IVA and 5 with IVB disease treated by PIHP until December, 1997. The mean age and tumor diameter were 55 and 7.7 cm, respectively. Twenty-two had portal vein invasion, 13 had hepatic vein invasion, and all patients had multiple intrahepatic metastases of more than 5 tumor foci. The PIHP with adriamycin or cisplatin was undertaken in a total of 50 treatments in these 36 patients. CR was observed in 6 and PR in 13 with an overall response rate of 59%, excluding 4 patients who were not evaluable. Five of 6 patients with CR remain free of disease at 7 to 54 months after the first treatment. The overall survival rate was 67% at 1 year and 32% at 5 years. The survival rates of Stage IVA patients (1-year = 71%, 5-year = 36%) were higher than Stage IVB patients (1-year = 20%, 5-year = 0%). The 5-year survival rates of patients with vascular invasion (Vp1-3 = 23%, Vv1-3 = 8%) were lower than those without it (Vp0 = 47%, Vv0 = 51%). These results indicated that PIHP achieved a 5-year survival rate of approximately 40% in patients with multiple advanced hepatocellular carcinoma in the absence of distant organ metastases and marked vascular invasion, and yielded complete long-term remission in some of these patients.