Background/Aims
The study proposed to evaluate the efficacy of anticancer drugs of intraarterial chemoinfusion and investigate prognostic factors influencing survival. Methods: A total of 127 patients diagnosed as having advanced hepatocellular carcinoma(HCC) of same stage (TNM stage IVa) from 1996 to 1998 were examined. Two intraarterial infusion chemotherapeutic regimens were employed: Adriamycin(Group I) and Cisplatin(Group II). Results: Overall survival was significantly diffrent(10.0 vs 5.7months) and favored Group I. By the univariate analysis, significant prognostic factors included: age, portal vein thrombosis(PVT), size(>5cm) and type of tumor, response rate (size & -fetoprotein) at 3 months after therapy, level of albumin, alkaline phosphatase, and total bilirubin. After repeated therapy, Group I showed better survival (14.0 vs 7.9 months), but there was no statistical difference in survival rate between two groups in the case of large size, PVT, and diffuse type. Conclusion: Group I showed better survival than Group II in advanced HCC of TNM stage IVa. But, considering prognostic factors, there was no significant difference in survival rate between two groups except small size or nodular type of HCC. TNM classification of stage IVa should be reconsidered to include prognostic factors influencing survival rate such as PVT, size and type of HCC.

Background/Aims
A prospective study was performed to evaluate the efficacy of low dose administration of cisplatin (CDDP) and 5-fluorouracil (5-FU) by repeated arterial infusion via a percutaneously implantable port system (PIPS) for advanced hepatocellular carcinoma (phase II trial). Methods: Ten patients with hepatocellular carcinoma belonging to TNM stage IV, but without extrahepatic spread, were enrolled. Nine patients had main portal vein thrombosis. All the patients were positive for HBsAg. Patients were repeatedly treated with an arterial infusion of CDDP and 5-FU (10 mg and 250 mg, respectively, for 5 hours on days 1-5) via a PIPS at four week intervals. The response was assessed by dynamic CT after two courses of chemotherapy. Results: Insertion of PIPS was successful in 8 of 10 patients. Two patients could not receive a second course of chemotherapy because one died of progressive hepatic failure and the other developed local infection and pseudoaneurysm formation. All the remaining 6 patients exhibited tumor progression after two courses of chemotherapy. The median survival time was 89 days (range, 59-204). The causes of death were progressive hepatic failure in one patient and uncontrolled esophageal variceal bleeding in one patient. Conclusions: Arterial infusion chemotherapy with CDDP and 5-FU via a PIPS was not an effective treatment for patients with advanced hepatocellular carcinoma.(Korean J Hepatol 2001;7:61-67)

Background/Aims
Advanced hepatocellular carcinoma with portal vein thrombosis has a poor prognosis. This study was undertaken to evaluate the therapeutic effects of concurrent chemo-radiation therapy in advanced hepatocellular carcinoma with portal vein thrombosis. Methods: A total of 54 patients with advanced hepatocellular carcinoma (TNM stage IVa) were enrolled. Nineteen patients were treated with external beam radiotherapy (4,500 cGy/ 5 weeks) and intrahepatic arterial 5-FU infusion (500 mg on 1-5 day and 30-35 day, respectively) via implanted chemoport. The others were treated with intrahepatic arterial cisplatin infusion (80 mg/m²). Results: In patients treated with concurrent chemo-radiation therapy, response rates at 2nd and 6th months were 42.1% and 26.3%, respectively. In patients treated with intrahepatic arterial cisplatin therapy, response rates at 2nd and 6th months were 2.9% and 0%, respectively. The median survival time was 11.6 months in concurrent chemo-radiation therapy and 4.8 months in intrahepatic arterial cisplatin infusion therapy. Concurrent chemo-radiation therapy produced better response rates and longer survival time than those of intrahepatic arterial cisplatin infusion therapy (p<0.05). Conclusions: Concurrent chemo-radiation therapy achieved favorable results in advanced hepatocellular carcinoma with portal vein thrombosis and can be considered as a treatment option for the management of advanced hepatocellular carcinoma.(Korean J Hepatol 2002;8:71-79)