Evaluation of conservative therapeutic modalities for hepatocellular carcinoma--analysis of 206 cases.

The clinical effectiveness of conservative therapeutic modalities for hepatocellular carcinoma (HCC) was evaluated in terms of extension of survival. The therapeutic methods included one-shot therapy (OST) using Mitomycin C (MMC), Adriamycin (ADM), simultaneous ADM & MMC, with or without transcatheter arterial embolization (TAE). Prior to estimating the effectiveness, the subjects were graded into three stages according to the pretreatment severity of their residual liver function, based on total bilirubin, aspartate aminotransferase/alanine aminotransferase ratio, and ascites as constituent factors. OST with or without TAE significantly prolonged the mean survival time in stage I cases in good condition and in stage II cases in fair condition, but not in stage III cases in poor condition. Concerning OST without TAE, the results of ADM were slightly better than MMC in terms of extension of survival. OST combined with TAE was far more effective than OST without TAE. Extension of survival by simultaneous ADM & MMC is now under observation, but the toxicity of the modality has so far not proved serious. The long-term influence of repeated TAE on liver function was revealed to be mild within an average observation period of approximately one year. This study confirmed the validity of the present staging system in evaluating the efficacy of OST and TAE in terms of extension of survival.