Treatment for extrahepatic metastasis of hepatocellular carcinoma following successful hepatic resection

BACKGROUND/AIMS: Recent advances in both the diagnosis and treatment of hep atocellular carcinoma (HCC) have improved its prognosis. Intrahepatic recur rence after hepatectomy can be treated with repeated hepatectomy, transhepa tic arterial embolization (TAE), percutaneous ethanol injection therapy (PE IT), or microwave coagulo-necrotic therapy. However, treatment for extrahep atic recurrence is also important in prolonging survival in some patients. METHODOLOGY: After radical hepatectomy in 155 patients, extrahepatic recurr ences were found in 15 patients that underwent subsequent treatment. The in terval between completing treatment for the primary tumor and the discovery of metastasis, the location and mode of treatment of the metastasis, and t he outcomes were analyzed. RESULTS: Distant metastasis was detected at a mean of 7 months after radica l resection of the primary tumor. Location of the metastasis included lung, bone, and adrenal gland. Four patients had no intrahepatic recurrence and 11 patients had simultaneous intrahepatic recurrence. Six patients with int rahepatic and extrahepatic recurrence that underwent systemic chemotherapy had poor prognoses, and all died within 12 months as a result of progressio n of the intrahepatic tumor. Five patients with intra- and extrahepatic rec urrence that underwent systemic chemotherapy combined with hepatic arterial infusion chemotherapy had relatively good outcomes; all survived for more than 12 months. CONCLUSIONS: These results suggest that to obtain a good prognosis for extr ahepatic metastasis coexisting with intrahepatic recurrence, intrahepatic r ecurrence should be controlled by locoregional therapy, and extrahepatic me tastasis should be controlled by systemic chemotherapy and/or irradiation t herapy.