[New approach for unresectable primary liver cancer--intra-arterial combination chemotherapy during and after operation with local injection of ethanol].

From 1976 to 1988, hepatic arterial infusion chemotherapy was performed in 52 patients with unresectable hepato-cellular carcinomas. Forty-nine (94%) out of 52 patients were stage III or stage IV. Thirty-five patients underwent continuous infusion of 5-FU and MMC employing chronometric infusion pumps. Mean survival of this group was 9 months. Six patients survived more than 12 months; the longest survivor died of different causes 40 months after surgery. Another patient lived for 30 months. In 10 patients, hepatic arterial ligation was performed in combination with infusion chemotherapy in the hepatic artery. Mean survival of these patients was 14 months. Four out of the 10 patients survived over 12 months. Recently, in 7 patients whose liver tumors were less than 4 cm in diameter and/or whose tumors were multiple and had liver disfunction, ethanol injection into the tumors during laparotomy was performed in combination with hepatic arterial infusion chemotherapy. In these 7 patients, an injection port system was implanted subcutaneously for intermittent infusion chemotherapy of MMC + 5-FU and ADM + lipiodol. Mean survival in this group was 14 months. One of 7 patients died 21 months after operation, but the others are alive at this writing. Five of these 6 patients have survived more than 12 months. AFP levels decreased in 3 patients after these treatments. In one case, AFP decreased to normal range for 18 months. These results suggested that intraoperative ethanol injection therapy into the tumors combining with hepatic arterial infusion chemotherapy may be of value for unresectable smaller liver carcinomas, since this method is technically easy and can assure injection of ethanol into the tumors during laparotomy.