Ruolo della polichemo-embolizzazione nel trattamento dei tumori primitivi e secondari del fegato.

Unresectable primary hepatocellular carcinoma (HC) and liver metastases (LM) of abdominal tumors (AT) in progression after systemic chemotherapy (CT) have a poor prognosis and few therapeutic options. From 12/91 to 10/93 we treated 20 patients (PTS) 11 men and 9 women, with HC (10) and AT (10) with the following PCE: percutaneous placement of intraarterial hepatic catheter, superselective embolization with lipiodol (5 cc), infusion, mixed with lipiodol, of epirubicine 40 mg/m2, 5-fluorouracil 700 mg/m2, mitomycin-C 10 mg/m2 in 30'. After infusion, the arterial tree was embolized with Ivalon until an almost complete slowing of arterial blood-flow, every 5-6 weeks (W). After a median follow-up of 28 W a total of 35 courses had been administered to 20 PTS. Median (M) age was 69 years. MPS was 2. Okuda stage in HC PTS: 1 stage I, 9 stage II, in 10 HC PTS, positive for hepatitis B virus, CT and b-IFN had failed, while 10 AT PTS (5 colorectal, 2 gastric, 1 uterine, 1 larynx, 1 choledochus) had progressed, after, at least, 2 CT regimens, and had only LM. Median time from the diagnosis of LM in AT PTS was 32 W (12-68). Toxicity: liver enzyme elevation and LDH elevation were 3 times baseline values, 4 PTS had fever for 6 days, 3 PTS had ileus for 3 days. No myelosuppression was observed. M α-fetoprotein value decreased from 468 ng/ml, to 56 ng/ml after PCE. Objective responses in 20 evaluable PTS: CR 5 PTS (25%), PR 7 PTS (35%), SD 5 PTS (25%), PD 3 PTS (15%), RR 60% (95% C.I. 38 x 82%). Median response duration was 23 W (12-96), HC 21 W, AT 24 W. Median overall survival was 56 W (4-104): AT PTS 66 W, HC PTS 19 W. 2 HC PTS became operable after PCE. PCE is a useful palliative procedure, with low toxicity, for AT and HC, unresectable and unresponsive to systemic therapy.