Comparative study on the comparative efficacy of hepatic arterial or portal venous infusion of adriamycin to control hepatic carcinoma growth

To compare the efficacy of intrahepatic arterial and intraportal venous infusions of anticancer drugs, the following two experiments were performed. 1. Adriamycin (3 mg kg) aqueous solution (ADR) was administered into hepatic artery (HA group) and portal vein (PV group) of a rabbit with 2 cm diameter VX2 liver tumor. The ADR levels of the tumor tended to be about 3-fold higher in HA than in PV group (p less than 0.1) one hour after ADR infusion. No significant difference was seen in the ADR levels of liver, heart, kidney, and bone marrow between the two groups. The ADR concentration ratio of tumor to liver was significantly higher in HA group than in PV group. 2. VX2 tumor cells (1 x 10(7) cells) were transplanted through the portal vein of the rabbit. ADR aqueous solution (1 mg/kg, 5 ml) was infused into the rabbit liver via HA and PV, at 3, 5, and 7 days after tumor inoculation. The rabbits were killed and the livers were excised 21 days after tumor implantation. The number of VX2 tumor nodules on the liver surface was less in HA group than in PV group. These results suggest that hepatic arterial infusion of anticancer drug is more useful to inhibit the growth of liver tumor than portal venous infusion.     

Influence of the routes of continuous intrahepatic infusion of 5-fluorouracil on its pharmacokinetics

Continuous infusion chemotherapy via hepatic artery using newly available mechanical devices is frequently used to treat hepatic metastases to achieve a high concentration of 5-fluorouracil (5-FUra) in the hepatic circulation while minimizing systemic exposure. We compared four routes of intrahepatic administration to find out the best one in the canine model. To ascertain this data, 5-FUra (30 mg/kg) was given as a continuous infusion over a 3 hr period into either a systemic vein (femoral), portal vein, hepatic artery, or hepatic artery distal to its ligation after hepatic dearterialization. A total of eight dogs were studied. During 5-FUra infusion, concomitant blood samples were taken from the inferior vena cava and hepatic vein at 1, 2, 3, 5, 10, 15, 30, 60, 120, and 180 min. 5-FUra levels were determined in plasma by high-performance liquid chromatography. Blood flow in the portal vein and hepatic artery was measured by an electromagnetic flowmeter. The data described by a multicompartmental model, including the measured flows, had separate hepatic arterial and portal compartments with elimination from each described by linear kinetics. Mean area under the curve values in microgram/ml X min and the ratios of the systemic/hepatic vein areas following 5-FUra infusion via systemic, portal vein, hepatic artery, or hepatic artery after dearterialization routes were: 975/539 (R = 1.80), 939/748 (R = 1.35), 211/454 (R = 0.46), and 562/1,424 (R = 0.39). The results indicated that the administration of 5-FUra via the hepatic arterial route distal to its ligation results in the highest hepatic vein drug levels with the smallest systemic/hepatic vein exposure ratio, followed by intra-arterial route, while systemic and portal vein routes were not nearly as advantageous as the intra-arterial routes.     

Effects of disseminative route on the liver- and lung-colonizing efficiencies of B16 melanoma and colon-26 carcinoma in mice

Tumor-colony formation in the liver and lungs of mice was assessed, after delivery of equal numbers of B16 melanoma or colon-26 carcinoma cells via the portal vein or the hepatic artery, and via the pulmonary artery or the bronchial artery. Significantly greater lung involvement occurred after delivery of both cell types via the bronchial artery than via the pulmonary artery. In the case of colon-26 cells, liver colonization via the hepatic artery was more efficient than via the portal vein. In the case of B16 cells, no route-dependent differences in liver colonization were detected. Our results indicate that during hematogenous metastasis, the vascular route taken by some cancer cells to the same target organ may considerably modify the efficiency with which they form metastases.     

Increased adriamycin levels in hepatic implants of rabbit Vx-2 carcinoma from regional infusion

Regional infusion chemotherapy for the treatment of primary or secondary hepatic cancer should allow delivery of a higher drug concentration to the tumor with decreased systemic exposure when compared with systemic therapy. Fifteen rabbits, each implanted with two hepatic Vx-2 tumors, were treated with infusion of Adriamycin (3 mg/kg and 7.5 muCi of [14C]Adriamycin) through the hepatic artery (n = 5), portal vein (n = 5), and a systemic vein (n = 5) at 20 mg/min. 99Tc-labeled macroaggregated albumin flow images documented specific hepatic perfusion in selected rabbits using this technique. Thirty min after infusion the animals were sacrificed, and multiple specimens of liver, tumor, and heart were taken for liquid scintillation counting and high-performance liquid chromatography. The 14C label remained associated with Adriamycin and metabolites. After systemic infusion 11.5 nmol/g of Adriamycin were found in tumor, and 32.4 nmol/g were found in liver. Infusion of Adriamycin through the hepatic artery produced drug levels of 34.3 nmol/g of tumor and 48.4 nmol/g of liver, while infusion through the portal vein produced drug levels of 6.5 nmol/g of tumor and 54.4 nmol/g of liver. The drug concentration in tumor was significantly higher after hepatic artery infusion compared with systemic (P less than 0.05) or portal vein (P less than 0.01) infusion. The tumor/liver ratio of [14C]Adriamycin tissue levels after hepatic artery infusion was greater than that measured after systemic vein treatment (no overlap of the 90% confidence intervals). Systemic infusion of Adriamycin produced a higher level of Adriamycin in the heart (13.6 nmol/g) than did hepatic artery (10.9 nmol/g) or portal vein (8.9 nmol/g) infusion. Hepatic artery infusion achieved the highest tumor Adriamycin level compared with systemic vein and portal vein infusion. The results suggest that these tumor implants are supplied primarily by the hepatic artery, that clearance of Adriamycin is efficient after regional infusion, and that systemic toxicity may be reduced using intraarterial infusion of Adriamycin for hepatic tumors.     

Reduction of hepatic metastases in rabbits by administration of an oily anticancer agent into the portal vein

We studied a prophylactic chemotherapy against hepatic metastases arising from the shedding of tumor cells into the portal circulation. The therapy was done with a lymphographic oily contrast medium, Lipiodol, and a high molecular weight anticancer agent named poly(styrene-maleic acid) copolymer conjugated neocarzinostatin (SMANCS), developed in our laboratory. SMANCS was dissolved in Lipiodol by sonication (SMANCS/Lipiodol, 1 mg of SMANCS in 1 ml of Lipiodol). Twelve rabbits were simply inoculated with the highly malignant carcinoma VX-2. Fifteen rabbits were given injections of SMANCS in glucose and Lipiodol into the portal vein and were subsequently inoculated with the tumor cells. Eighteen were given injections of SMANCS/Lipiodol and then the tumor cells. These rabbits were killed 12 days later. Thirteen were given injections of the tumor cells alone and were allowed to survive. Sixteen were given injections of SMANCS/Lipiodol and then with the tumor cells; they were allowed to survive. Rabbits given injections of SMANCS/Lipiodol before tumor inoculation had significantly fewer (P less than 0.001) metastases than those not treated or those given SMANCS in glucose and Lipiodol. Survival was significantly longer [P less than 0.005; 36.0 +/- 7.7 (SD) days] with SMANCS/Lipiodol before tumor inoculation than without treatment [23.5 +/- 3.0 days]. SMANCS/Lipiodol has a prolonged anticancer effect because it remains in the portal vein and allows sustained drug release from the oil (Lipiodol) to aqueous spaces. Hepatic metastases might be prevented by portal administration of the appropriate oily anticancer agent.     

双泵化疗在大肠癌肝转移中的应用

目的 探讨肝动脉加门静脉灌注化疗（双泵化疗）在大肠癌肝转移中的价值。方法 30例大肠癌肝转移患者术后2周开始接受灌注化疗。其中采用双泵化疗（I组）12例,肝动脉灌注化疗（Ⅱ组）10例,门静脉灌注化疗（Ⅲ组）8例。3组化疗方案的剂量频次均相同。结果 肝转移灶治疗有效率（CR＋PR）Ⅰ组为66．7％,Ⅱ组为60．0％,Ⅲ组为37．5％。0．5,1,2年生存率I组分别为100．0％、75．0％、41．7％;Ⅱ组为90．0％、60．0％、30．0％;Ⅲ组为87．5％、50．0％、25．0％。结论 双泵灌注化疗是大肠癌肝转移治疗和预防的一种有效辅助手段,其疗效优于单纯肝动脉灌注化疗或门静脉灌注化疗。     

A new approach to chemoembolization therapy for hepatoma using ethiodized oil, cisplatin, and gelatin sponge

This article reports on a new approach to hepatic arterial chemoembolization therapy using ethiodized oil (Lipiodol, Ultra Fluide), cisplatin, and gelatin sponge (Gelfoam, Upjohn, Kalamazoo, MI) for hepatocellular carcinoma (HCC). The anticancer effects of this therapy on 20 patients who underwent subsequent hepatic resection were evaluated mainly by histologic examination. All main tumors were reduced in size following this therapy. It is notable that in 65% of the patients the tumor size was reduced to less than 50% of that before therapy. All the values of serum alpha-fetoprotein (AFP) in the patients who exhibited pretreatment levels exceeding 100 ng/ml dropped by more than 50%, and in 55% of them it fell below 20 ng/ml. The concentration of platinum in the tumor tissue was significantly higher than that in the nontumorous tissue. In 15 of 20 patients (75%), the main nodules were completely necrotic. Thirteen of the patients had daughter nodules and/or small intrahepatic metastases (Group A); nine had tumor emboli in the portal (hepatic) vein (Group B); 17 had intracapsular invasions (Group C); and ten had extracapsular invasions (Group D). The ratios of patients with completely necrotic cancer cells in Group A were nine of 13 (69%); in Group B, seven of nine (78%), in Group C, 11/17 (65%); and in Group D, four of 10 (40%). In eight of the 20 patients (40%) no viable cancer cells were recognized at any foci. Lesions other than those with extracapsular invasion could be considerably eliminated with this form of therapy. It is expected that this method will become the therapy of choice not only for palliative treatment but also for preoperative treatment.     

Significance of duplex/colour Doppler sonography in hepatic arterial chemotherapy for patients with liver metastases from colorectal carcinoma.

AIMS: The aim of the study was to evaluate the importance of duplex/colour Doppler ultrasound in a protocol of hepatic regional chemotherapy, by measuring the blood flow in the hepatic artery, portal vein, hepatic veins, and inferior caval vein of patients with unresectable liver metastases from colorectal carcinoma. METHODS: Thirty-nine consecutive subjects were selected for this study, including 21 patients who had unresectable histologically confirmed liver metastases from colorectal carcinoma (Group A), and 18 asymptomatic volunteers as normal controls (Group B). All subjects of Groups A and B were examined using duplex/colour Doppler sonography. After the ultrasound study, all patients of Group A were submitted to the administration of high dose mitomycin C into the hepatic artery, with concomitant detoxication of post-hepatic venous blood. RESULTS: The mean value of the hepatic artery blood flow was significantly higher (P=0.0009) in liver metastases patients (361 ml/min, SEM=24 ml/min) than in normal controls (245 ml/min, SEM=20 ml/min). Also, the mean Doppler perfusion index was higher in liver metastases patients than in normal controls. For each patient of Group A, the total dose of mitomycin C to be infused was calculated based on the blood flow in the hepatic artery. In this way the concentration of mitomycin C in the hepatic artery was always greater than 3 microg/ml. The duration of detoxication was calculated based on the blood flow in the inferior caval vein. For two patients only, the blood flow was lower than 1000 ml/min, with the necessity to protract the duration of detoxication over 2 hours. CONCLUSIONS: The measurement of the blood flow in hepatic vessels of patients with liver metastases seems to be very important in establishing the total dose of drug which has to be infused in hepatic arterial chemotherapy, and to determine the duration of concomitant detoxication of post-hepatic venous blood.     

肝癌肝动脉、门静脉双途径栓塞化疗的临床观察

目的观察中晚期肝癌肝动脉、门静脉双途径栓塞性化疗及在此基础上综合治疗的疗效。方法40例肝癌患者随机分为A、B两组。A组20例行肝动脉碘油栓塞化疗(TAE)及无水酒精注射(PEI)治疗;B组20例在肝动脉碘油栓塞化疗1~3次后予门静脉碘油栓塞化疗(PVE)及无水酒精注射治疗。结果近期疗效,A、B两组接受治疗后肿块均有不同程度缩小,且B组优于A组,远期疗效,A组接受治疗后1、2、3年的生存期分别是55%、25%、5%;B组为75%、35%、10%,统计学上具有显著性意义,P<0.05。在治疗期间没有出现严重并发症。结论肝动脉、门静脉双途径碘油栓塞化疗联合无水酒精注射治疗,取得较好治疗效果,能有效延长肝癌患者的生存期,是目前中晚期肝癌综合治疗中比较满意的治疗方法。     

Prophylactic therapy for liver metastasis of gastrointestinal carcinomas using biological response modifiers (BRM): fundamental studies on the inhibition of experimental liver metastasis by intraportal administration of OK-432

For prophylactic therapy to inhibit hepatic metastatic recurrence after surgical treatment of gastro-intestinal carcinomas, the effects of OK-432, a biological response modifier (BRM), were examined with inoculation of tumor cells and administration of OK-432 via portal vein. Experiments with the inhibition of liver metastasis were performed as follows. The animals were divided into five groups. Group 1: 1.0 KE of OK-432 was given intraportally 5 minutes after injection of 5.0 X 10(6) tumor cells per rat via the portal vein. Group 2: Non-medicated group, only 5.0 X 10(6) tumor cells per rat were injected into portal vein, as the control for group 1. Group 3: 0.5 KE of OK-432 and 2.5 X 10(6) tumor cells per rat were used. Group 4: 1.0 KE of OK-432 and 2.5 X 10(6) tumor cells were used. Group 5: Non-medicated group, injected with 2.5 X 10(6) tumor cells as the control group for groups 3 and 4. Colonies of metastases in the liver of each group were examined by autopsy on the 30th day after treatment. Metastases were observed in 75% of group 1, 100% of group 2, 58.8% of group 3, 64.3% of group 4 and in 90% of group 5. For the investigation of the mechanisms to inhibit these liver metastases, 51Cr labeled AH60C tumor cells were injected into the portal vein, and the remained of radioactivity in rat liver was examined. The result showed that OK-432 injected into the portal vein did not directly kill the lodging tumor cells. To prove the morphological evidence of inhibition of hepatic metastasis, the changes of tumor cells were microscopically observed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Microcirculation of hepatic nodules from diethylnitrosamine-treated rats

The microcirculation of nodules (0.5 to 10 mm in diameter) from diethylnitrosamine-treated rats was studied in perfused livers. Microlight guides were placed on nodules and surrounding tissue on the capsular surface of the liver to measure fluorescence due to fluorescein-dextran (12 microM), a dye confined to the vascular space, infused via the hepatic artery and portal vein separately or simultaneously. The fluorescence increase due to fluorescein-dextran infusion via the artery and vein simultaneously was used to compare vascular space in nodules with that of surrounding tissue. The vascular space of nodules less than 1 mm in diameter was only about one-half as large as that of surrounding tissue. In contrast, in nodules 1 to 2 mm in diameter, the vascular space was similar to values from surrounding tissue. This was largely due to an increase in the fluid entering via the artery. As nodules grew from 2 to 10 mm in diameter, the vascular space decreased as a function of nodule size to 40% of surrounding tissue. The sum of fluorescence increases due to fluorescein-dextran infused via the artery and vein separately always equalled values obtained from simultaneous infusions. From these measurements, the fraction of vascular fluid observed by the microlight guide that entered the liver via the artery was calculated. In tissue surrounding nodules, fluid entering from the artery was 19% of the total, a value approximating the fraction of fluid pumped into the liver via the artery (25%). The percentage of fluid in the nodule that entered the liver via the hepatic artery increased progressively to 100% of the total as nodules grew from 2 to 10 mm in diameter. Thus, nodules become increasingly dependent on the hepatic artery and less dependent on blood supply via the portal vein as they grow.     

肝细胞癌伴门静脉癌栓不同治疗方法的比较

目的 比较肝细胞癌合并门静脉癌栓(ｔｕｍｏｒ ｔｈｒｏｍｂｉ ｉｎ ｐｏｒｔａｌ ｖｅｉｎ,ＰＶＴＴ）不同治疗方法的疗效及其意义。方法 １４７例肝细胞癌伴门静脉主干或第１分支癌栓的住院患者,按不同治疗方法分成４组：保守治疗组（Ａ组,１８例）;肝动脉结扎和（或）肝动脉插管化疗组（Ｂ组,１８例）,术后定期栓塞化疗;肝癌联同ＰＶＴＴ切除组（Ｃ组,７９例）;手术切除＋肝动脉化疗栓塞和（或）肝动脉置管或门静脉     

Enhancement of Tumor Proliferation by Cyclosporine A in Early Phase of Experimental Hepatic Metastasis

The effect of cyclosporine A (CsA) on in vivo growth of hepatic metastasis was studied. Murine colon 38 tumor cells (1 × 10⁵) were inoculated via the superior mesenteric vein. Mice were grouped depending on CsA dosage and time schedules: Group A: CsA 30 mg/kg body weight on the 7, 8 and 9th post tumor inoculation days hy gavage; Group B: CsA 15 mg/kg body weight 30 min before tumor inoculation and 2 times more at 24 h intervals; Group C: CsA 30 mg/kg body weight at the same dose timing as Group B. Measurement of the diameter of the largest tumor serially by weekly laparotomy up to 4 weeks revealed that the tumor growth rates were significantly greater in Groups B and C than those in Group A or the control (without CsA). The mean tumor doubling times in the control, and Groups A, B and C were 2.2±1.3, 2.0±0.5, 1.5±0.4 and 1.3±0.8 days, respectively. The mean tumor numbers of hepatic metastasis were 13.2±8.3, 11.3±7.3, 19.4±8.7 and 19.6±6.8, respectively. Values of tumor proliferation index obtained by bromodeoxyuridine immunohistochemistry were 10.0±6.1%, 14.9±8.0%, 28.6±8.2% and 30.1±12.4%, respectively, with significant differences (Groups B and C vs. A or control, P <0.05). In vitro MTT assay showed that cell viability rates were greater than 100% in the medium containing CsA concentrations of less than 10⁻⁷ mol/liter. However, a cytostatic effect of CsA was apparent at higher concentrations. In contrast to the previous in vivo finding of a cytostatic effect of CsA on tumor cells, we found a cytoproliferative action when CsA was administered early in the course of metastatic tumor implantation in the liver. The mechanism of cytoproliferative effect of CsA is unknown but may involve multiple factors.     

Adjuvant chemotherapy for colorectal hepatic metastases: role of route of administration and timing.

Improved results in the adjuvant and therapeutic treatment of colon cancer has led to renewed interest in the role of adjuvant chemotherapy following liver resection for colorectal hepatic metastases. However, little is known about the most effective method or timing of delivery of adjuvant chemotherapy. Sixty-nine BD-IX rats underwent a right hepatic lobectomy following tumour inoculation via a splenic injection of 10(7) K12/TRb colon cancer cells. The rats were then randomized to receive systemic FUdR (1 mg kg-1 d-1 for 7 d) or regional (hepatic artery or portal vein) FUdR (2 mg kg-1 d-1 for 7 d) immediately or 72 h following tumour injection. On Day 28, a laprotomy was performed, and tumour nodules in the liver were counted. The animals were followed to death, and at autopsy the cause of death from hepatic or extrahepatic metastases was determined. All methods of FUdR infusion were superior to no treatment. Immediate portal vein (PV) FUdR infusion delayed the appearance of hepatic tumour (P = 0.003), changed the cause of death from hepatic to extrahepatic disease (P = 0.019), and prolonged survival (P < 0.05). Infusion of FUdR via the PV 72 h later did not delay the appearance of hepatic tumours nor prolong survival. In contrast, delayed HA FUdR infusion controlled hepatic metastases (P = 0.04) and improved survival (P < 0.05).     

Tumor and liver drug uptake following hepatic artery and portal vein infusion

Anatomic dye injection studies of the blood supply of colorectal hepatic metastases suggest that tumors are supplied predominantly by the hepatic artery. Using 13N amino acids with dynamic gamma camera imaging in patients with colorectal hepatic metastases, it has been shown that hepatic artery infusion results in a significantly greater nutrient delivery to tumor compared with portal vein infusion. However, direct measurements of drug levels in tumor following hepatic artery and portal vein infusion in humans have not previously been reported. Patients with metastatic colorectal cancer confined to the liver received fluorodeoxyuridine (FUdR) through the hepatic artery or through the portal vein. All patients had previously failed systemic chemotherapy. Five patients with hepatic artery catheters were matched (by age, serum lactic dehydrogenase levels, percent hepatic replacement, and tumor size) with five patients with portal vein catheters. At operation, 3H-FUdR (1 microCi/kg) and 99mTc-macroaggregated albumin (MAA) (6 mCi) were injected into the hepatic artery or portal vein. Liver and tumor biopsies were obtained two and five minutes later. 3H and 99mTc were measured per gram tissue by scintillation and gamma counting. The mean liver levels following hepatic artery infusion (23.9 +/- 11.4 nmol/g) and portal vein infusion (18.4 +/- 14.5 nmol/g) did not differ. However, the mean tumor FUdR level following hepatic artery infusion was 12.4 +/- 12.2 nmol/g, compared with a mean tumor FUdR level following portal vein infusion of 0.8 +/- 0.7 nmol/g (P less than .01). This low level of tumor drug uptake after portal vein infusion of FUdR predicts minimal tumor response to treatment via this route. Thus, regional chemotherapy for established colorectal hepatic metastases should be administered through the hepatic artery.     

Effect of hepatic artery ligation on the incorporation of 3H-orotic acid into an adenocarcinoma transplanted to rat liver

In the model of secondary liver cancer in Wistar rats a study was made of the influence of hepatic artery ligation (HAL) on the amount of nucleotides and RNA in tumor and liver tissue and on the uptake of 3H-orotic acid into these compounds and DNA after labelling for 90 minutes. Ten days after inoculation with tumor cells into the central liver lobe, a catheter was placed into the portal vein in all rats and in half of them the hepatic artery was ligated. On days one, three, five or ten, rats were given 3H-orotic acid through the catheter. On day ten 3H-orotic acid was also infused via the femoral vein or intraperitoneally. After HAL there was a decrease in the nucleotide and RNA content of the tumor cells after one, three and five days. There was no such decrease in the liver cells. In all HAL rats there was an increase in the nucleotide and RNA content of the tumor cells at day ten compared to day five. The ratio of RNA to acid soluble fraction labelling in tumors was also increased on day ten in all groups compared to HAL rats at day five. The increased uptake of 3H-orotic acid into tumour RNA at day ten after HAL strongly suggests rearterialization. There was no support for an increased vascularization of the tumor from the portal vein on day three or five. In the liver tissue, HAL had no influence. This experimental study gives no support for the use of hepatic dearterialization followed by intraportal infusion av cytostatic agents in clinical settings.     

Changes in hepatic blood flow during regional hyperthermia

The influence of liver hyperthermia on hepatic arterial and portal venous blood flow to tumour and normal hepatic tissue was examined in a rabbit VX2 tumour model. Hyperthermia was delivered by 2450 MHz microwave generator to exteriorized livers in 18 rabbits. Blood flow was measured in both portal vein and hepatic artery using radioactive tracer microspheres before, during and 5 min after intense (greater than 43 degrees C) hyperthermia. During hyperthermia a decrease in total liver blood flow was composed primarily of a decrease in hepatic arterial blood flow to tumour tissue. Tumours were supplied almost exclusively by the hepatic artery and thus total tumour blood flow was significantly depressed during heating. The decreased tumour blood flow persisted after the cessation of hyperthermia and was indicative of vascular collapse in the tumour tissue. Temperature differentials in tumour compared to normal tissue ranged from 5 degrees C to 8 degrees C during hyperthermia because of the lower tumour blood flow. The portal vein exerted minimal influence on temperatures attained in the tumour tissue during hyperthermia but would have mediated normal liver tissue heat loss.     

碘化油阿霉素肝动脉及门静脉支分期栓塞治疗原发性肝癌

Despite recent advances in hepatic surgery, management of unresectable carcinoma of the liver is still a challenging problem. From September 1988 through March 1989, 10 primary liver cancer patients were treated by hepatic artery embolization (HAE) using lipiodol-adriamycin with or without hepatic artery ligation (HAL). One of them received HAE twice in seven weeks. In two of these patients, following right HAE and HAL, right portal vein embolization (PVE) by catheterization via the ileac vein was performed. Transcatheter portal vein embolization via the ileac vein was simple, easy and safe even it was impossible to expose the hepatic hilum. All patients are alive from 7 to 12 months after operation except one who died of hepatic failure after having survived for 54 days. There was marked alleviation of symptoms and tumor shrinkage was observed in 9 out of 10 patients. HAE and PVE using lipiodol-adriamycin may have the potential of improving the therapeutic effect in patients with hepatocellular carcinoma.     

肝动脉门静脉栓塞治疗肝癌

本文首次报告碘化油加抗癌药经肝动脉门静脉栓塞治疗不能手术切除的晚期肝癌9例,计肝细胞癌7例,胆管细胞癌1例,结肠癌术后肝转移1例。5例为巨块型肝细胞癌(直径为7～16cm),4例为多发结节型。X线证实有4/7的肝细胞癌侵犯了肝内门静脉,提示门静脉内用药的必要性。治疗后,5例巨块型病灶明显缩小,AFP增高者术后均有不同程度下降。生存 15、12、9、8和 6个月者各为1,2,1,2和2例,1例失访。     

原发性肝癌合并门静脉瘤栓的化疗栓塞治疗

将116例合并门静脉主干或左右大分支瘤栓的原发性肝癌分为三组,A组32例,采用单纯肝动脉灌注化疗法;B组66例,采用常规肝动脉化疗加碘油和明胶海绵栓塞法;C组18 例,采用肝段或亚肝段动脉化疗加碘油和明胶海绵栓塞。结果示,A组6、12、18和24个月生存率分别为25 .0%(8/32)、9 .4%(3/32)、3 1%(1/32)和0(0/32),门脉瘤栓消失率为3 .1% (1/32); B 组6、12、18 和24 个月生存率分别为53 .0% (35/66)、25. 8% (17/66)、9 .1%(6/66)和3 0%(2/66),门脉瘤栓消失率为19 .7%(13/66);C组6、12、18 和24 个月生存率分别为72 .2%(13/18)、44 .4%(8/18)、22. 2%(4/18)和11. 1%(2/18),门脉瘤栓消失率为44 .4%(8/18)。各组生存率(P<0 .05)及门脉瘤栓消失率(P<0 .01)差异均有统计学意义。初步观察结果提示,经肝动脉化疗及栓塞法是治疗合并门脉瘤栓原发性肝癌的有效方法,且栓塞法优于单纯灌注化疗法,特别是肝段或亚肝段动脉化疗栓塞法疗效更好。