Efficacy of repeated percutaneous isolated liver chemoperfusion in local control of unresectable hepatocellular carcinoma.

BACKGROUND/AIMS: Percutaneous isolated liver chemoperfusion (PILP) with hepatic venous isolation and charcoal hemoperfusion (HVI-CHP) enables high-dose intraarterial infusion of cytotoxic agents while reducing systemic toxicity. We report here the effect of repeated PILP with HVI-CHP on local control of unresectable hepatocellular carcinoma (HCC).

METHODOLOGY

After placement of a hepatic arterial infusion (HAI) catheter, a 4-lumen-2-balloon catheter (24F) was introduced into the retrohepatic inferior vena cava through the femoral vein, and the balloons were inflated to accomplish HVI. During HAI of adriamycin (60-150 mg/m2), total hepatic venous outflow was captured via fenestrations of one major lumen between the balloons and pumped out into CHP filters. The filtered blood was returned to the right atrium through the end opening of another major lumen of the catheter. Of 30 patients, 8 had repeated PILP in a range of 2-4 treatments, and 22 had a single treatment.

RESULTS

Eleven (52%) of 21 evaluable patients in the single PILP group and 7 out of 8 patients (88%) in the repeated PILP group had partial or complete response. Median durations of response in responding patients were 6 and 21 months in the single and the repeated PILP groups, respectively (p=0.02). The 1- and 2-year survival rates (single vs. repeated) were 57% vs 88%, and 29% vs 70%, respectively (p=0.05).

CONCLUSIONS

Repeated PILP could be performed safely in patients with advanced HCC and significantly prolonged the duration of remission in patients with unresectable HCC.