Combination therapy of percutaneous mitoxantrone injection, percutaneous ethanol injection, and transcatheter arterial embolization for intrahepatic hepatocellular carcinoma and adrenal metastasis

We treated a 63-year-old man who had recurrent large hepatocellular carcino mas (>5cm in diameter) and left adrenal metastasis with the combination app roach of percutaneous intratumoral chemotherapy with mitoxantronc, percutan eous ethanol injection, and transcatheter arterial embolization. He receive d repeated transcatheter arterial embolization and percutaneous ethanol inj ection combination therapy for intrahepatic hepatocellular carcinomas, whic h controlled his disease for 6 months from the first treatment. After that, left adrenal metastasis was detected by biopsy specimen. Therefore, we rep eated more transcatheter arterial embolization and percutaneous ethanol inj ection to the liver and left adrenal gland, but this combination therapy co uld not control the hepatocellular carcinomas in these organs. With the pat ient's consent, he was treated with the combination approach of percutaneou s intratumoral chemotherapy with mitoxantrone, percutaneous ethanol injecti on, and transcatheter arterial embolization for hepatocellular carcinomas o f the liver and left adrenal gland. After this combination therapy, we foll owed-up the viable lesions by color Doppler ultrasonography and computed to mography examination. However, we could not detect these viable lesions of hepatocellular carcinomas in his body until one month before he died, When the degree of hepatic failure worsened due to the natural course of cirrhos is, this combination therapy was stopped 7 months before he died. He died o f pulmonary tumor emboli from metastasis of inferior vena cava 24 months af ter the combination therapy started. However, on autopsy there was almost n o remaining hepatocellular carcinoma found in the main lesions of liver and left adrenal gland. We suggest that a combination approach of percutaneous intratumoral chemotherapy with mitoxantrone, percutaneous ethanol injectio n, and transcatheter arterial embolization may be indicated in elderly case s of intrahepatic large hepatocellular carcinoma and adrenal metastasis, wh ich are not under control only by transcatheter arterial embolization and p ercutaneous ethanol injection.