Treatment of unresectable hepatocellular carcinoma : Results of a randomized controlled trial
Tóm tắt
Most patients with hepatocellular carcinoma present late with unresectable disease and, to date, an effective and safe palliative treatment has not been found. From December 1971, to December 1981, a randomized controlled trial was conducted to evaluate the following treatments against a control group receiving only symptomatic therapy (group I) : hepatic dearterialization (group II), hepatic artery ligation and cannulation for infusion of chemotherapeutic agents (group III), hepatic artery ligation and portal vein cannulation for chemotherapeutic agents infusion (group IV), and external irradiation (group V). Response to various treatments was assessed with respect to symptomatic relief and duration of survival. A total of 166 patients with histologically confirmed tumor confined to the liver were studied. All patients had similar preoperative general status and biochemical findings. Patients in group IV had the best symptomatic improvement; 58.6% responded to some degree. Hepatic artery ligation intraportal infusion (group IV) offered significantly longer survival than infusion via the intra-arterial route (group III) (p = 0.023). However, when compared with the control group, the survival times in the 4 treatment groups were not significantly different. Hepatic dearterialization (group II) had the highest 7-day mortality rate, 33.3%. The results of this trial suggested that none of the modalities of treatment studied offered patients with unresectable hepatocellular carcinoma any better survival and symptomatic palliation than did symptomatic treatment alone.
Tài liệu tham khảo
Lee, N.W., Wong, J., Ong, G.B.: The surgical management of primary carcinoma of the liver. World J. Surg.6:66, 1982
Breedis, C., Young, G.: The blood supply of neoplasms in the liver. Am. J. Pathol.30:969, 1954
Larmi, T.K.I., Karkola, P., Klintrup, H.E., Heikkinen, E.: Treatment of patients with hepatic tumors and jaundice by ligation of the hepatic artery. Arch. Surg.108:178, 1974
Madding, G.F., Kennedy, P.A., Sogemeier, E.: Hepatic artery ligation for metastatic tumor in the liver. Am. J. Surg.120:95, 1970
Balasegaram, M.: Complete hepatic dearterialization for primary carcinoma of the liver. Report of twentyfour patients. Am. J. Surg.124:340, 1972
Almersjo, O., Bengmark, S., Rudenstam, C.M., Hafstrom, L., Nilsson, L.A.V.: Evaluation of hepatic dearterialization in primary and secondary cancer of the liver. Am. J. Surg.124:5, 1972
Ansfield, F.J., Ramirez, G., Skibba, J.L., Bryan, G.T., Davis, H.L., Wirtanen, G.W.: Intrahepatic arterial infusion with 5-fluorouracil. Cancer5:1147, 1971
Gulesserian, H.P., Lawton, R.L., Condon, R.E.: Hepatic artery ligation and cytotoxic infusion in treatment of liver metastases. Arch. Surg.105:280, 1972
Fortner, J.G., Mulcare, R.J., Solis, A., Watson, R.C., Golbey, R.B.: Treatment of primary and secondary liver cancer by hepatic artery ligation and infusion chemotherapy. Ann. Surg.178:162, 1973
Murray-Lyon, I.M., Parsons, V.A., Blendis, L.M., Dawson, J.L., Rake, M.O., Laws, J.W.: Treatment of secondary hepatic tumours by ligation of hepatic artery and infusion of cytotoxic drugs. Lancet2:172, 1970
Ariel, I.M., Pack, G.T.: Treatment of Cancer and Allied Diseases of the Gastrointestinal Tract, vol. 1. New York, Hoeber, 1964, p. 477
Ong, G.B., Chan, P.K.W., Alagaratnam, T.T.: Clinical trials of inoperable primary carcinoma of the liver. Bull. Soc. Int. Chir.5:391, 1975
Ong, G.B., Chan, P.K.W.: Primary carcinoma of the liver. Surg. Gynecol. Obstet.143:31, 1976
Ong, G.B.: Techniques and Therapies for Primary and Metastatic Liver Cancer, vol. 2, R.C. Hickey, editor. Chicago, Year Book Medical Publishers, 1977, p. 39
Ariel, I.M., Pack, G.T.: Treatment of inoperable cancer of the liver by intra-arterial radioactive isotopes and chemotherapy. Cancer20:793, 1967
Kaplan, E.L., Meier, P.: Nonparametric estimation from incomplete observation. J. Am. Stat. Assoc.53:457, 1958
Okamoto, E., Tanaka, N., Yamanaka, N., Toyosaka, A.: Results of surgical treatments of primary hepatocellular carcinoma: Some aspects to improve longterm survival. World J. Surg.8:360, 1984
Tang, Z., Yang, B., Tang, C., Yu, Y., Lin, Z., Weng, H.: Evaluation of population screening for hepatocellular carcinoma. Chin. Med. J.93:795, 1980
Lai, C.L., Lam, K.C., Wong, K.P., Wu, P.C., Todd, D.: Clinical features of hepatocellular carcinoma: Review of 211 patients in Hong Kong. Cancer47:2746, 1981
Okuda, K., Obata, H., Nakajima, Y., Ohtsuki, T., Okazaki, N., Ohnishi, K.: Prognosis of primary hepatocellular carcinoma. Hepatology4:3S, 1984
Bengmark, S., Rosengren, K.: Angiographic study of the collateral circulation to the liver after ligation of the hepatic artery in man. Am. J. Surg.119:620, 1970
Nilsson, L.A.V., Zettergren, L.: Effect of hepatic artery ligation on induced primary liver carcinoma in rats: Preliminary report. Acta. Pathol. Microbiol. Scand.71:187, 1967
Ackerman, N.B., Lien, W.M., Silverman, N.A.: The blood supply of experimental liver metastases. III. The effects of acute ligation of the hepatic artery or portal vein. Surgery71:636, 1972
Bengmark, S., Fredlund, P., Hafstrom, L.O., Vang, J.: Present experiences with hepatic dearterialization in liver neoplasm. Progr. Surg.13:141, 1974
Michels, N.A.: Collateral arterial pathways to the liver after ligation of the hepatic artery and removal of the celiac axis. Cancer6:708, 1953
Bengmark, S.: Palliative Behandlung von metastatischem Leberkrebs and pathophysiologische Bemerkungen. Schweiz. Med. Wochenschr.99:571, 1969
Nagasue, N., Inokuchi, K., Kobayashi, M., Ogawa, Y., Iwaki, A., Yukaya, H.: Hepatic dearterialization for nonresectable primary and secondary tumors of the liver. Cancer38:2593, 1976
Okuda, K.: Liver Cancer Study Group of Japan: Primary liver cancers in Japan. Cancer45:2663, 1980
The Liver Cancer Study Group of Japan: Primary liver cancer in Japan. Cancer54:1747, 1984
Cochrane, A.M.G., Murray-Lyon, I.M., Brinkley, D.M., Williams, R.: Quadruple chemotherapy versus radiotherapy in treatment of primary hepatocellular carcinoma. Cancer40:609, 1977
Barone, R.M., Byfield, J.E., Goldfarb, P.B., Frankel, S., Ginn, C., Greer, S.: Intra-arterial chemotherapy using an implantable infusion pump and liver irradiation for the treatment of hepatic metastasis. Cancer50:850, 1982
Sakurai, M., Okamura, J., Kuroda, C.: Transcatheter chemo-embolization effective for treating hepatocellular carcinoma—a histopathologic study. Cancer54:387, 1984