RESUMO
BACKGROUND/AIMS: To compare intra-arterial (regional) hepatic chemotherapy with doxorubicin, to the systemic (intravenous) one in patients with non-resectable (Stage IVA) hepatocellular carcinoma. METHODOLOGY: Seventy-two patients with inoperable hepatocellular carcinoma were randomized to receive doxorubicin 50 mg/m2 as a bolus infusion either via an implantable intra-arterial catheter (Group A) or as systemic chemotherapy (Group B) every 21-28 days. RESULTS: Patients of Group A had a higher rate of objective and subjective remissions and Karnofsky performance status improvement in comparison to Group B. The mean survival was 7 months (range: 2-16) for Group A and 6.5 months (range: 1-13) for Group B, but this difference was not statistically significant. The quality of life remained at an acceptable level until death in both groups. CONCLUSIONS: A slight but not statistically significant superiority of intra-arterial chemotherapy against the systemic one is concluded.
Assuntos
Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/tratamento farmacológico , Doxorrubicina/administração & dosagem , Infusões Intra-Arteriais , Neoplasias Hepáticas/tratamento farmacológico , Cuidados Paliativos , Idoso , Antineoplásicos/efeitos adversos , Biópsia , Carcinoma Hepatocelular/patologia , Relação Dose-Resposta a Droga , Doxorrubicina/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Infusões Intravenosas , Fígado/patologia , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
The main cause of death after hepatic resection for colorectal liver metastases is tumor recurrence. An improvement in survival may be achieved by resection of recurrent hepatic metastases as previously reported. In this paper we report our experience with 13 repeated liver resections in 11 patients. The post-operative mortality was 8% and the morbidity was 23% with two biliary tract fistulas and one recurrent pleural effusion. The median survival time from the first hepatic resection was 23 months, but differed according to the length of the disease-free interval (more than 1 year and less than 1 year: 49 and 17 months, respectively (P < 0.05). Our results suggest that repeated hepatic resection is technically a safe procedure and may be beneficial to selected patients. All candidates should be carefully evaluated pre-operatively for extrahepatic disease.
