Abstract

Transarterial chemo-embolization using adriamycin or cisplatin, lipiodol and gelfoam (TACE-Adr or -CDDP) has been recommended for the treatment of hepatocellular carcinoma (HCC), which are not indicated for the curative therapy, such as liver transplantation, operation, and radiofrequency ablation therapy (RFA). However, TACE-Adr/-CDDP protocol is effective only for single or few nodular HCCs with largest diameter less than 6 cm and without major vascular involvement or distant metastasis (AJCC/UICC 6th.edition-TNM-II). To treat more complicated far advanced HCCs, various multiplicinary approaches have been tried, but most studies are too preliminary and immature to be used as standard treatment protocols. In such situation, a combination protocol, called TACE-EC/F, in which TAC-Epirubicin and Cisplatin is followed by systemic intra-venous infusion of 5-fluorouracil (5-FU), has been a good option. To improve its therapeutic efficacy, I replaced its systemic 5-FU (for 5 days continuous) infusion part to the (one time) percutaneous intratumoral injection chemotherapy (PIC) with a mixture of high dose 5-FU and recombinant interferon-gamma (IFN-gamma), named PIC-IF. This protocol was developed based on both the
results
of several experimental data and many clinical experience of percutaneous ethanol injection therapy (PEIT). This TACE-EC/PIC-IF protocol showed a possibility of new multimodality approach for the treatment of advanced HCC.

• Keywords: Hepatocellular carcinoma; 5-Fluorouracil; Interferon-gamma; Intratumoral injection chemotherapy