PREOPERATIVE AND POSTOPERATIVE ADJUVANT TARGETING LOCOREGIONAL CHEMOTHERAPY COMBINED WITH LOCOREGIONAL TARGETING IMMUNOSTIMULATION AND SURGICAL RESECTION FOR HEPATOCELLULAR-CARCINOMA - A NEW PROMISING ALTERNATIVE

Hepatocellular carcinoma remains a challenging disease with a poor pro gnosis in terms of outcome and overall survival. Although resectional liver surgery remains the optimal treatment option, it is associated w ith a high incidence of intrahepatic recurrence. We present our experi ence of a new multimodality treatment approach for the management of p atients with hepato-cellular carcinoma (HCC), consisting of liver rese ction in combination with induced targeting locoregional, pre- and pos t- operative chemotherapy and immunotherapy in 20 patients with HCC. T wenty patients (15 male and 5 female) with HCC were included in the pr esent study. All patients had preoperative selective hepatic artery di gital angiography, two courses of induced transarterial targeting loco regional chemotherapy and one series of 5 courses of targeting locoreg ional immunotherapy, at 20 days intervals. Three weeks later, all pati ents underwent resectional liver surgery. one month after surgery, and at monthly intervals, all surviving patients had 4 courses of transar terial induced targeting locoregional chemotherapy-immunotherapy. To t reat persistent residual pathology in the liver remnant, additional co urses of regional targeting chemotherapy-immunotherapy were carried ou t via the subcutaneously implanted pump in 5 patients. All 20 patients had major liver resection. Three patients died from liver failure bec ause of advanced liver cirrhosis, 25, 29 ar d 32 days after surgery re spectively. Histology of the resected specimens revealed complete (n=4 ) or advanced (n-14) tumour necrosis in 18 out of the 20 patients. In the remaining 2 patients moderate tumour necrosis was confirmed. Posto perative residual pathology was seen in 7 patients, but it was been el iminated in all of them after postoperative induced transarterial targ eting locoregional chemotherapy-immunotherapy. Overall survival ranged from 6 to 20 months, mean survival 13 months. In conclusion, resectio nal liver surgery combined with pre- and post- operative induced targe ting locoregional chemotherapy-immunotherapy is associated with promis ing results regarding possible decrease or elimination of intrahepatic recurrence of HCC after liver resection and satisfactory overall surv ival.