[Clinical study of low-dose cisplatin and 5-fluorouracil chemotherapy via implanted fusion port in 20 patients with advanced hepatocellular carcinoma with portal vein tumor thrombosis].

We experienced 20 cases of advanced hepatocellular carcinoma with portal vein tumor thrombosis treated with low-dose cisplatin and 5-fluorouracil (5-FU) chemotherapy via implanted fusion port between August 1999 and September 2003. A fusion port was implanted by inserting an intraarterial catheter into the hepatic artery. Cisplatin (10 mg/day, 5 times/week, 4 weeks) and 5-FU (250 mg/day, 5 times/week, 4 weeks) were administered for one cycle. The treatment was performed repeatedly until the patient showed progressive disease (PD) with an off period of 4 to 12 weeks. The average number of cycles was 1.7+/-0.73. Responses were complete response (CR) 0/20, partial response (PR) 6/20, no change (NC) 8/20, and PD 6/20, and the overall response rate was 30%. The 1-year survival rate was 48.5%, and the average observation period was 357 days. The toxicities of grade 3 and above were leukocytopenia (2 cases; 10%), thrombocytopenia (2 cases; 10%), nausea (1 case; 5%), and epigastralgia (1 case; 5%). Complications with reservoir implantation included 2 cases of catheter dislocation, 1 case of wound separation,1 case of bleeding from the port implantation site, 1 case of development of collateral circulation,and 1 case of catheter occlusion. The outcomes were survival in 5 cases (25%) and death in 15 cases (75%). The causes of death included cancer (12 cases; 60%), varices rupture (2 cases; 10%),and hemoptysis (1 case; 5%). The group with a CLIP score of 3 or less showed a significantly higher survival rate than the group with a CLIP score of 4 or more (survival rates were 80% and 12.5%, respectively; p=0.0032, logrank test). Among CLIP score factors, tumor morphology (TM) was particularly related to life convalescence,and TM 1 group with the tumor occupying less than half of the liver showed a significantly higher survival rate than the TM 2 group with the tumor occupying more than half of the liver (p=0.0003, logrank test) with one-year survival rates of 88.9% and 10.9%, respectively. CLIP score and TM were also significantly reflected in life convalescence on multivariate analysis. While low-dose cisplatin and 5-FU chemotherapy via an implanted fusion port were regarded as a useful therapeutic regimen to improve life convalescence for cases of progressive hepatocellular carcinoma with portal vein tumor thrombosis (Vp 3/4), life convalescence in those with a CLIP score of 3 and above,particularly in the TM 2 group, was poor. We consider that treatment in such cases should be decided carefully, taking into consideration their quality of life.