NORADRENALINE GUIDED SELECTIVE CHEMOEMBOL IZATION OF HEPATOCELLULAR-CARCINOMA

Despite the postulated tumor affinity of Lipiodol is liver dysfunction after chemoembolization of hepatic malignancies common. Vasoconstrict ing action of noradrenaline to protect non malignant tissue was studie d. 70 patients with unresectable HCCs (UICC IV: 61%) were treated via percutaneous catheter. After noradrenaline (0,1-0,8 mg) induced and do cumented vessel constriction a suspension of Lipiodol (5-8 ml) and Mit omycin C (10-20 mg) was injected. In addition minced dehydrated dura s uspended in Lipiodol occluded the major tumour feeding vessels. 120 (7 3%) of a total of 164 chemoembolizations were performed after intrahep atic noradrenaline (0,1-0,8 mg) bolus injection. Arterial perfusion of non malignant liver parenchyma was significantly reduced in 95%. 24 h ours later selective tumor retention of lipiodol was noticed in 67%. S ide effects were fever (79%), thoraco-abdominal pain (67%), nausea and emesis (43%) and tachycardia (15%). There were two treatment related deaths: one each from liver failure and cardiac arrest. By WHO respons e criteria there were 17 (23%) partial remissions (PR), 34 (49%) stabl e diseases (SD) and 20 (28%) patients had progression (PD). The median survival time from initiation of treatment was 312 days. Bilobal and multiple tumors reduced survival time (90 days). These finding suggest that noradrenaline guided chemoembolization is feasible in Europe and even in patients with plyethrombosis well tolerated.