Influence of prognostic groupings and treatment results in the management of unresectable hepatoma: Experience with cis-platinum-based chemoradiotherapy in 76 patients

被引:9
作者
Abrams, RA
Cardinale, RM
Enger, C
Haulk, TL
Hurwitz, H
Osterman, F
Sitzmann, JV
机构
[1] JOHNS HOPKINS UNIV HOSP, JOHNS HOPKINS ONCOL CTR, DIV BIOSTAT, BALTIMORE, MD 21287 USA
[2] JOHNS HOPKINS UNIV HOSP, DEPT SURG, DEPT RADIOL, BALTIMORE, MD 21287 USA
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 1997年 / 39卷 / 05期
关键词
hepatoma; carcinoma; hepatocellular; alpha-fetoproteins; AFP; radiotherapy; cisplatin; infusions; intraarterial;
D O I
10.1016/S0360-3016(97)00389-1
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Internationally, hepatoma is a common cause of cancer death. Although the only curative therapy is surgical, most tumors are unresectable and cause death. The value of nonsurgical, antineoplastic therapy for such tumors is controversial. This study was undertaken to extend and confirm promising, but preliminary, treatment observations in the unresectable context. Methods and Materials: From 1988 to 1993, 76 patients with unresectable, biopsy proven, hepatoma underwent uniform pretreatment assessment followed by induction therapy with external beam radiotherapy (21 Gy/7 fractions/10 days) and intravenous Cisplatinum, 50 mg/m(2). One month later patients began monthly intrahepatic artery Cisplatinum, 50 mg/m(2). Clinical course and treatment outcomes were correlated with previously published prognostic factors and groupings (Nomura ef al., Okuda et al., Stillwagon, et at). Results: The toxicity of this therapy was modest and nonlimiting. Twenty-four patients (32%) progressed during induction and prior to receiving two cycles of intrahepatic artery Cisplatinum without evidence of benefit. Patients showing this early progression were more likely to be Stillwagon unfavorable than favorable (p = 0.013), Okuda Stage II than Stage I (p = 0.024), and slightly but not statistically more likely to be alpha-fetoprotein positive than alpha-fetoprotein negative (p = 0.098). The overall objective response rate was 43% (38% among AFP positive and 62% among AFP negative patients) (p = 0.15). Although 21 patients had evidence of extra hepatic metastases, survival for these patients did not differ from patients without metastases (p = 0.09) and patients with extra hepatic metastases were just as likely to show intrahepatic response (p = 0.84). Conclusion: The chemoradiotherapy program utilized produced objective response and minimal toxicity. One-third of patients progressed rapidly in spite of treatment. Among the remaining patients, response occurred frequently. This treatment appears to represent an important therapeutic option for many, but not all, patients with unresectable hepatoma. (C) 1997 Elsevier Science Inc.
引用
收藏
页码:1077 / 1085
页数:9
相关论文
共 51 条
[1]  
BEAHRS OH, 1992, MANUAL STAGING CANCE
[2]   PRIMARY-TREATMENT OF HEPATOCELLULAR-CARCINOMA BY ARTERIAL CHEMOEMBOLIZATION [J].
BISMUTH, H ;
MORINO, M ;
SHERLOCK, D ;
CASTAING, D ;
MIGLIETTA, C ;
CAUQUIL, P ;
ROCHE, A .
AMERICAN JOURNAL OF SURGERY, 1992, 163 (04) :387-394
[3]  
BRUCKNER H W, 1990, Cancer, V66, P135
[4]  
BUSCARINI L, 1991, ONCOLOGY-BASEL, V48, P26
[5]   PROGNOSTIC FACTORS OF HEPATOCELLULAR-CARCINOMA IN THE WEST - A MULTIVARIATE-ANALYSIS IN 206 PATIENTS [J].
CALVET, X ;
BRUIX, J ;
GINES, P ;
BRU, C ;
SOLE, M ;
VILANA, R ;
RODES, J .
HEPATOLOGY, 1990, 12 (04) :753-760
[6]   CLINICAL PHARMACOKINETICS OF INTRAARTERIAL CISPLATIN IN HUMANS [J].
CAMPBELL, TN ;
HOWELL, SB ;
PFEIFLE, CE ;
WUNG, WE ;
BOOKSTEIN, J .
JOURNAL OF CLINICAL ONCOLOGY, 1983, 1 (12) :755-762
[7]  
Cox D. R., 1984, ANAL SURVIVAL DATA
[8]  
ENGSTROM PF, 1990, CANCER, V65, P2641, DOI 10.1002/1097-0142(19900615)65:12<2641::AID-CNCR2820651207>3.0.CO
[9]  
2-R
[10]  
EPSTEIN B, 1991, CANCER, V67, P896, DOI 10.1002/1097-0142(19910215)67:4<896::AID-CNCR2820670407>3.0.CO