Effective hepatic artery chemoembolization for advanced hepatocellular carcinoma with extensive tumour thrombus through the hepatic vein

Background and Aims: Advanced hepatocellular carcinoma (HCC) with extensive tumour growth through the hepatic vein still has an extremely poor prognos is, even after cancer chemotherapy and/or transarterial embolization. Altho ugh aggressive surgical treatments using extracorporeal circulation and liv er transplantation have been performed by some authors, the reported result s were still unsatisfactory. In this study, we report the favourable result of hepatic artery chemoembolization and subsequent surgical resection in t hree patients with advanced HCC With extensive tumour thrombus through the hepatic vein. Methods and Results: Three irresectable patients with HCC with extensive tu mour thrombus through the hepatic vein underwent hepatic artery chemoemboli zation with aclarubicin, mitomycin C, lipiodol and/or Gelfoam. After the re duction of tumour extent with hepatic artery chemoembolization, two of the three patients underwent surgical resection. These two patients are still a live at 59 and 21 postoperative months, respectively. In the other case, th e extent of the tumour and functional reserve of the liver prevented us fro m performing surgical resection, bur the patient is doing well 62 months af ter the initial treatment. Conclusions: Hepatic artery chemoembolization with aclarubicin, mitomycin C , lipiodol and/or Gelfoam might be an effective treatment for irresectable advanced HCC with extensive tumour thrombus into the inferior vena cava or the right atrium through the hepatic vein. Radical surgical resection might be applicable for selected patients without high surgical risk after reduc ing tumour extent by hepatic artery chemoembolization. (C) 1999 Blackwell S cience Asia Pty Ltd.