INFLUENCE OF PROGNOSTIC GROUPINGS AND TREATMENT RESULTS IN THE MANAGEMENT OF UNRESECTABLE HEPATOMA - EXPERIENCE WITH CIS-PLATINUM-BASED CHEMORADIOTHERAPY IN 76 PATIENTS

Purpose: Internationally, hepatoma is a common cause of cancer death. Although the only curative therapy is surgical, most tumors are unrese ctable and cause death. The value of nonsurgical, antineoplastic thera py for such tumors is controversial. This study was undertaken to exte nd and confirm promising, but preliminary, treatment observations in t he unresectable context. Methods and Materials: From 1988 to 1993, 76 patients with unresectable, biopsy proven, hepatoma underwent uniform pretreatment assessment followed by induction therapy with external be am radiotherapy (21 Gy/7 fractions/10 days) and intravenous Cisplatinu m, 50 mg/m(2). One month later patients began monthly intrahepatic art ery Cisplatinum, 50 mg/m(2). Clinical course and treatment outcomes we re correlated with previously published prognostic factors and groupin gs (Nomura ef al., Okuda et al., Stillwagon, et at). Results: The toxi city of this therapy was modest and nonlimiting. Twenty-four patients (32%) progressed during induction and prior to receiving two cycles of intrahepatic artery Cisplatinum without evidence of benefit. Patients showing this early progression were more likely to be Stillwagon unfa vorable than favorable (p = 0.013), Okuda Stage II than Stage I (p = 0 .024), and slightly but not statistically more likely to be alpha-feto protein positive than alpha-fetoprotein negative (p = 0.098). The over all objective response rate was 43% (38% among AFP positive and 62% am ong AFP negative patients) (p = 0.15). Although 21 patients had eviden ce of extra hepatic metastases, survival for these patients did not di ffer from patients without metastases (p = 0.09) and patients with ext ra hepatic metastases were just as likely to show intrahepatic respons e (p = 0.84). Conclusion: The chemoradiotherapy program utilized produ ced objective response and minimal toxicity. One-third of patients pro gressed rapidly in spite of treatment. Among the remaining patients, r esponse occurred frequently. This treatment appears to represent an im portant therapeutic option for many, but not all, patients with unrese ctable hepatoma. (C) 1997 Elsevier Science Inc.