Debulking surgery followed by intraarterial 5-fluorouracil chemotherapy plus subcutaneous interferon alfa for massive hepatocellular carcinoma with multiple intrahepatic metastases: a pilot study

Abstract

Background: The prognosis in advanced hepatocellular carcinoma (HCC) with multiple intrahepatic metastases is extremely poor. Combination therapy with subcutaneous interferon (IFN) alfa and intraarterial 5-fluorouracil was reported to be effective against such advanced HCC. We describe results of debulking surgery followed by combination therapy with IFN alfa and 5-FU for massive HCC with multiple intrahepatic metastases.

Methods: In 27 HCC patients with massive tumors and multiple intrahepatic metastases, we performed combination therapy with IFN alfa and 5-FU after maximal liver tumor resection.

Results: Mean patient age was 63.3 years. Including intrahepatic metastases, tumors numbered 5 or more in 17 patients (63%). Portal or hepatic vein branches were invaded in 22 (81%). The mean maximum tumor diameter was 102 mm. Among 24 patients whose results were analyzed, an objective response by residual intrahepatic metastases was observed in 13 (54%; complete response in 12, and partial response in 1). Overall 1-, 3-, and 5-year survival was 73.2%, 38.7%, and 38.7%, respectively; 1-, 3-, and 5-year progression-free rates were 38.2%, 22.3%, and 22.3%.

Conclusions: Debulking surgery followed by IFN alfa and 5-FU combination chemotherapy offers possibility of long-term survival despite massive HCC with multiple intrahepatic metastases.

Keywords: 95% confidence interval; AFP; CDDP; CH; CI; CT; CT with arterioportography; CTAP; CTx; ECOG; Eastern Cooperative Oncology Group; FU; GI; HBV; HCC; HCV; Hepatocellular carcinoma; Hx; ICGR15; IFN; Intraarterial chemotherapy; LC; NBNC; NL; PIVKA; PS; RR; Reduction surgery; Survival; TACE; US; chemotherapy; chronic hepatitis; cisplatin; computed tomography; fluorouracil; gastrointestinal; hepatectomy; hepatitis B virus; hepatitis C virus; hepatocellular carcinoma; indocyanine green retention rate at 15 min; interferon; liver cirrhosis; non-B viral, non-C viral; normal liver; prediction score; protein induced by vitamin K absence; relative risk; transcatheter arterial chemoembolization; ultrasonography; α-fetoprotein.