High-Dose Intraarterial Chemotherapy using HVI·DHP in the Management of Recurrent Hepatoma after Surgery with Special Reference to Patterns of Intrahepatic Metastases -Comparison with TAE-

Masahiro Tominaga, Yonson Ku, Yoichi Saitoh

First Department of Surgery, Kobe University School of Medicine

We compared the efficacy of high-dose intraarterial chemotherapy using direct hemoperfusion under hepatic venous isolation (HVI·DHP) and transcatheter arterial embolization (TAE) in the treatment of recurrent hepatocellular carcinoma after hepatectomy with special reference to the number and distribution of intrahepatic metastases (IM). Intrahepatic recurrences were categorized into four types: type I, unilobar, no of tumors<3; type II, unilobar, no. of tumors≥3; type III, bilobar, no. of tumors<3; type IV, bilobar, no. of tumors≥3. Both clinical and macroscopic stages tended to be more high grade in patients treated with HVI·DHP than those given TAE. In types II and IV, HVI·DHP treated patients had significantly higher tumor response (CR+PR) rates than TAE patients (p<0.05). Type IV recurrence showed a longer duration of response (p<0.05) and longer survival time with HVI·DHP than TAE, while type II recurrence showed a similar response duration and survival time, regardless of treatment. Thus, we concluded that HVI·DHP is more effective than TAE in patients with type IV recurrence after hepatectomy and that HVI·DHP is the treatment of first choice, especially for those with multiple bilobar lesions.

Key words
hepatocellular carcinoma, transcatheter arterial embolization, hepatic venous isolation, direct hemoperfusion

Reprint requests
Yonson Ku First Department of Surgery, Kobe University School of Medicine
7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650 JAPAN

Accepted
July 6, 1994

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