Pre- and post- operative adjuvant targeting locoregional chemotherapy combined with locoregional targeting immunostimulation and surgical resection for hepatocellular carcinoma. A new promising alternative.

Hepatocellular carcinoma remains a challenging disease with a poor prognosis in terms of outcome and overall survival. Although resectional liver surgery remains the optimal treatment option, it is associated with a high incidence of intrahepatic recurrence. We present our experience of a new multimodality treatment approach for the management of patients with hepatocellular carcinoma (HCC), consisting of liver resection in combination with induced targeting locoregional, pre- and post-operative, chemotherapy and immunotherapy in 20 patients with HCC. Twenty patients (15 male and 5 female) with HCC were included in the present study. All patients had preoperative selective hepatic artery digital angiography, two courses of induced transarterial targeting locoregional chemotherapy and one series of 5 courses of targeting locoregional immunotherapy, at 20 days intervals. Three weeks later, all patients underwent resectional liver surgery, one month after surgery, and at monthly intervals, all surviving patients had 4 courses of transarterial induced targeting locoregional chemotherapy-immunotherapy. To treat persistent residual pathology in the liver remnant, additional courses of regional targeting chemotherapy-immunotherapy were carried out via the subcutaneously implanted pump in 5 patients. All 20 patients had major liver resection. Three patients died from liver failure because of advanced liver cirrhosis, 25, 29 ar d 32 days after surgery, respectively. Histology of the resected specimens revealed complete (n = 4) or advanced (n - 14) tumour necrosis in 18 out of the 20 patients. In the remaining 2 patients moderate tumour necrosis was confirmed. Postoperative residual pathology was seen in 7 patients, but it was been eliminated in all of them after postoperative induced transarterial targeting locoregional chemotherapy-immunotherapy. Overall survival ranged from 6 to 20 months, mean survival 13 months. In conclusion, resectional liver surgery combined with pre- and post-operative induced targeting locoregional chemotherapy-immunotherapy is associated with promising results regarding possible decrease or elimination of intrahepatic recurrence of HCC after liver resection and satisfactory overall survival.