Intra-arterial chemotherapy followed by chemo-embolisation in unresectable hepatocellular carcinoma

Abstract Unresectable hepatocellular carcinoma is related to a poor prognosis. Encouraging response rates and survival have been reported with intra-arterial (i.a.) chemotherapy and chemo-embolisation, but limited data are available on the association of the two treatment modalities. We therefore started a new programme combining i.a. chemotherapy with chemo-embolisation. The treatment regimen consisted of l -leucovorin (100 mg/m 2 i.v.), 5-fluorouracil (800 mg/m 2 i.a.), and carboplatin (250 mg/m 2 i.a.). Chemo-embolisation with mitoxantrone (10 mg/m 2 ) plus ethiodized oil followed immediately. The same treatment plus gelatin sponge was given after 28 days. 26 patients entered the study and were evaluable for response and side-effects. Main patient characteristics were: males 21, females 5: median age 68 years (range 42–76 years); stage TNM II-III 17, IVA 9; Child's A 12, Child's B 14; elevated baseline α-fetoprotein 17; cirrhosis 25. 14 patients had a partial response (54%; 95% confidence interval 33–73%), 3 had stabilisation and 9 had progressive disease. Median survival was 11 months (range 2–20+). 16 patients had grade I–II pain and 15 grade I–II fever. Our results indicate that the regimen is safe, well tolerated and capable of inducing objective remissions in a high percentage of patients with hepatocellular carcinoma.