New research presented at the SIR annual meeting showed liver cancer patients with inoperable tumours can benefit from chemoembolisation, a non-surgical procedure where a high-dose of chemotherapy is delivered to the tumour while decreasing blood flow through the arteries feeding it.
By reducing blood flow to the tumour (embolisation) the embolic agent allows the chemotherapeutic drugs to remain localised to the tumour, decreasing harm to healthy tissues and allowing higher doses of the drugs to be used. Two studies presented at SIR showed that chemoembolisation does not induce liver toxicity, offers patients additional months, and is even safe for high-risk liver cancer patients who already have restricted blood flow in the liver due to portal vein thrombosis.
While surgical removal of liver tumours offers the best chance for a cure, they are unfortunately often inoperable because they may be too large or have grown into major blood vessels or other vital structures. Sometimes, many small tumours are spread throughout the liver, making surgery too risky or impractical. Surgical removal is not possible for more than two-thirds of primary liver cancer patients and 90% of patients with metastatic (secondary) liver cancer. Additionally, due to the compromised liver function of liver cancer patients, physicians must be careful that cancer treatments do not cause additional liver damage and toxicity, which could lead to death.
"Chemoembolisation offers patients a non-surgical option that preserves healthy tissue, is well tolerated and has a short recovery time. It can be repeated as needed to control tumour growth or progression, thereby extending life expectancy in the majority of cases," said lead investigator Dr Jeff Geschwind, director of interventional radiology and associate professor at Johns Hopkins University School of Medicine, Baltimore.
Geschwind and colleagues set out to evaluate the incidence of toxicity after treatment in liver cancers with chemoembolisation using the National Cancer Institute Common Toxicity Criteria system grading of adverse events. Between 1998 and 2003, 149 patients underwent 436 chemoembolisation procedures using a combination of cisplatin, doxorubincin, and mitomycin C, mixed in a carrier oily medium, followed by the embolic material. Fifty-eight percent of the tumours were primary hepatocellular carcinoma and 42% were metastatic tumours. Chemoembolisation was found to be safe with no periprocedural mortality and minimal changes in liver enzymes and blood counts.
Geschwind and his research team also examined the safety and survival data of hepatocellular carcinoma (HCC) patients with portal vein thrombosis who underwent chemoembolisation. The portal vein provides the major blood supply to the liver. Due to the already compromised blood supply to the liver, portal vein thrombosis has been considered a contraindication for chemoembolisation for inoperable HCC. The fear is that further compromise of the blood supply might push the patient into premature liver failure.
Thirty-one patients underwent one or more chemoembolisation treatments. All the patients tolerated the treatment without any immediate periprocedural complications.
Patient recovery was similar to those without portal vein thrombosis, with most discharged home the following day. Approximately half of the patients had poor initial liver reserve prior to chemoembolisation, and they had a median survival of five months, while the remainder showed a mean survival of 12 months. For comparison, the published survival rates of patients with inoperable HCC and portal vein thrombosis who receive no treatment is 3.7 months; and for those who receive systemic chemotherapy, 5.1 months. For patients with adequate hepatic reserve, chemoembolisation appears to offer a survival advantage despite the presence of PVT. The study showed that chemoembolisation is a safe treatment, even in high-risk patients.
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