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Intra-Arterial Folinic Acid and 5-Flurouracil Effective in Locally Advanced Hepatocarcinoma

Intra-arterial folinic acid and 5-flurouracil may benefit cirrhotic patients with locally advanced hepatocarcinoma, even in the presence of thrombosis, new research suggests.

Hepatocarcinoma generally has a poor prognosis, and the optimal treatment of locally advanced hepatocarcinoma remains controversial. Transcatheter arterial chemoembolisation of hepatocarcinoma is widely used but has not been fully investigated.

Roberto Mazzanti, MD, with the School of Medicine at the University of Florence, Italy, and colleagues wanted to determine whether intra-arterial chemotherapy with 5-flurouracil and folinic acid in locally advanced hepatocarcinoma is a viable alternative to existing therapies.

The researchers enrolled 24 consecutive inoperable patients (19 men and 5 women) with locally advanced hepatocarcinoma. Median age was 69 years, range 48 to 80 years.

Diagnosis of hepatocellular carcinoma was confirmed by ultrasound-guided liver biopsy and histopathological examination. Seven patients with portal vein thrombosis were also included in the study. Of them, 6 were affected by Child A stage cirrhosis and 1 had Child B stage cirrhosis.

All patients received intra-arterial chemotherapy via a surgically implanted port-a-cath. Folinic acid (100 mg/m²) and 5-flurouracil (up to 550 mg/m²) were administered on a 1-week or a 2-week schedule.

Of the 19 patients who completed the study, 2 completely responded, 11 partially responded, 6 had stable disease, and 4 showed disease progression. Median survival time was 19 (range 4-85) months. Child A patients showed a significant longer survival than Child B patients (P < .005).

However, no significant difference in survival was found between patients with or without portal vein thrombosis or between patients who had or had not undergone previous therapy. In addition, no hepatic or systemic toxicity was observed following 5-FU administration.

"Intra-arterial chemotherapy appears to be a possible strategy in the treatment of locally advanced hepatocellular carcinoma in cirrhotic patients, even in the presence of portal thrombosis," they conclude.


Dig Liver Dis 2004;36:278-285. "Treatment of locally advanced hepatocellular carcinoma by hepatic intra-artery chemotherapy: a pilot study"

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