ABSTRACT
The effects of combined transcatheter arterial chemoembolization (TACE) and radiotherapy in patients with large hepatocellular carcinoma (HCC) were analysed retrospectively. A total of 107 patients with large unresectable HCC was treated with TACE followed by external beam irradiation. The largest dimension of the tumours ranged from 5 cm to 18 cm. Acute effects, survival rates, toxicity and prognostic factors were analysed. Follow-up ranged from 4 months to 98 months (median 24 months). An objective response, i.e. reduction of tumour area greater than 50%, was achieved in 48.6% of cases. In 64.9% of the cases with increased alpha-feto protein (AFP) values, AFP level underwent a reduction of more than 25%. The cumulative survival rates at 1, 3 and 5 years were 59.4%, 28.4% and 15.8%, respectively (median survival 18 months). The combination therapy was generally well tolerated. Only two patients died from liver failure or variceal bleeding associated with therapy. The Cox proportional hazards model showed that the number of tumours and the irradiation dose were independent prognostic factors. The results indicate that combined TACE with radiotherapy is a promising therapeutic approach for large unresectable HCC. Prospective controlled trials to ascertain the real potential benefit of this approach are required.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Hepatocellular/therapy , Chemoembolization, Therapeutic/methods , Liver Neoplasms/therapy , Adult , Aged , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/radiotherapy , Cisplatin/administration & dosage , Combined Modality Therapy , Doxorubicin/administration & dosage , Female , Fluorouracil/administration & dosage , Humans , Liver Neoplasms/pathology , Liver Neoplasms/radiotherapy , Male , Middle Aged , Radiation Dosage , Retrospective Studies , Treatment OutcomeABSTRACT
This analysis indicated that patients with cancer-related pain account for 71.0% in author's material. After the TCM treatment, the effective rate were 91.6% in hepatocarcinoma-related pain; 86.1% in colon-rectal cancer-related pain; 68.2% in malignant lymphoma-related pain; 100% in irradiation-related pain of esophageal cancer, lung cancer, post-operative breast cancer. Results of "four-step analgesic ladder" showed that 52.1% of pain could be relieved by Step I (TCM therapy); if Step II (indomethacin) or III (phenylbutazone) was added, the rate of pain relief reached as high as 96.5%; and only 3.5% need to be treated by Step IV (Opioids). With less side-effects and addiction of opioids and other narcotics, the "four-step analgesic ladder" therapy seems to be more suitable for cancer pain relief in China.
Subject(s)
Drugs, Chinese Herbal/therapeutic use , Indomethacin/therapeutic use , Liver Neoplasms/complications , Pain, Intractable/drug therapy , Adult , Aged , Aged, 80 and over , Colonic Neoplasms/complications , Female , Humans , Male , Middle Aged , Narcotics/therapeutic use , Pain, Intractable/etiology , Phenylbutazone/therapeutic use , Rectal Neoplasms/complicationsABSTRACT
This paper reports the result of large liver cancer treated by moving strip whole liver irradiation from 1980 to 1988. The 5-year survival rate was 30.83% +/- 7.77% and the median survival time was 25.8 months. Analysis of factors affecting prognosis showed: 1. The higher the midplane tissue irradiation dose, the longer the survival (P less than 0.001) and 2. Patients with greater than or equal to 8 less than 13 cm tumor diameter and/or greater than or equal to 50% less than 75% tumor/liver volume ratio had longer survival than those with greater than or equal to 13 cm diameter and/or greater than or equal to 75% tumor/liver volume ratio (P less than 0.001). Traditional Chinese medicine was indispensable as a supplement to this treatment. Both clinical and experimental study suggested that this technique could improve the patient's final outcome.
Subject(s)
Carcinoma, Hepatocellular/radiotherapy , Drugs, Chinese Herbal/therapeutic use , Liver Neoplasms/radiotherapy , Adenoma, Bile Duct/drug therapy , Adenoma, Bile Duct/mortality , Adenoma, Bile Duct/radiotherapy , Adult , Aged , Carcinoma, Hepatocellular/drug therapy , Carcinoma, Hepatocellular/mortality , Combined Modality Therapy , Female , Humans , Liver Neoplasms/drug therapy , Liver Neoplasms/mortality , Male , Middle Aged , Survival RateABSTRACT
In 169 cases with liver cancer pain, the therapeutic effects of TCM and the authors' "analgesic therapy of four steps" were analysed. The results were that most patients with advanced liver cancer had mild pain, and only a small number of patients (14.2%) had moderate or severe pain. By the first step analgesic therapy, 46.1% of the patients were relieved and with the second or third step of analgesic therapy, 93.5% of the patients were relieved, only 6.5% of the patients with grade III pain needed the fourth step therapy. With TCM treatment alone, the remission rate of grade I and grade II pain was 100% and 76.9% respectively. "Analgesic therapy of four steps" produced less side effects or addiction to narcotics.
