SURVIVAL RESULTS AMONG PATIENTS WITH ALPHA-FETOPROTEIN-POSITIVE, UNRESECTABLE HEPATOCELLULAR-CARCINOMA - ANALYSIS OF 3 SEQUENTIAL TREATMENTS OF THE RTOG AND JOHNS-HOPKINS-ONCOLOGY-CENTER

PURPOSE To analyze the observed therapeutic impact of the postinductio n components of three treatment programs utilized sequentially between 1983 and 1991 for patients with unresectable alpha-fetoprotein-positi ve hepatoma. METHODS Over a 7.5-year period, three treatment regimens were sequentially utilized: (1) RTOG 83-19, (2) a Johns Hopkins Oncolo gy Center Institutional Pilot Program, and (3) RTOG 88-23. Each treatm ent program began with an induction phase of external-beam hepatic irr adiation (2100 cGy/7 fractions), with concurrent doses of intravenous chemotherapy intended to be radiosensitizing, After induction, patient s received cycles of one of the following: (1) intravenous doxorubicin and 5-fluorouracil (5-FU) with or without I-131-polyclonal antiferrit in (RTOG 83-19); (2) intrahepatic artery cisplatin (Hopkins Institutio nal Pilot); or (3) intrahepatic artery cisplatin with or without I-131 -polyclonal antiferritin (RTOG 88-23). Analysis of survival results wa s performed with multivariate and Cox regression methods, RESULTS The addition of intravenous I-131-polyclonal antiferritin to postinduction cycles of either intravenous doxorubicin and 5-FU or intrahepatic art ery cisplatin did not enhance survival. Intrahepatic artery cisplatin treatment yielded median survival duration of 9.1 months and survival at 12 and 24 months of 37% and 9%, respectively. These results were si gnificantly superior to those resulting from use of intravenous doxoru bicin and 5-FU (P = 0.0001; median survival duration 3.6 months; 12- a nd 24-month survival results 17% and 4%, respectively). A significant survival difference for the cisplatin regimen remained even when patie nts were stratified by previously identified prognostic factors and th e results were appropriately adjusted. CONCLUSION Patients with unrese ctable alpha-fetoprotein-positive hepatocellular carcinoma experienced improved survival and decreased toxicity when managed with postinduct ion cycles of intra-arterial cisplatin as compared with intravenous do xorubicin and 5-FU. Intravenous I-131-polyclonal antiferritin did not improve survival when added to either postinduction regimen but dramat ically increased hematologic toxicities.