進行肝細胞癌に対する経皮的肝灌流化学療法(<特集>がん疾患とアフェレシス)

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  • Percutaneous Isolated Hepatic Perfusion (PIHP) for Advanced Hepatocellular Carcinoma

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Percutaneous isolated hepatic perfusion for the treatment of hepatocellular carcinoma: technique, pharmacokinetics, clinical results. We have developed percutaneous isolated hepatic perfusion (PIHP) for the treatment of unresectable malignant liver tumors. We report here the surgical technique, pharmacokinetics, and effectiveness of PIHP in multiple advanced liver tumors. By December 2008, 126 patients with hepatocellular carcinoma (HCC) had undergone a total of 140 PIHPs. PIHP was accomplished mainly by the single-catheter technique using a novel 4-lumen, 2-balloon catheter; it was used to isolate and capture total hepatic venous outflow and, at the same time, to direct the filtered blood to the right atrium. Under PIHP, either adriamycin (60-100mg/m^2) or cisplatin (150-200mg/m^2) was infused via the hepatic artery. CR was observed in 29 and PR in 46 cases with an overall response rate of 60%. The survival rates of Stage IVA patients (1-year=61.5%, 5-year=23.5%) were higher than for Stage IVB patients (1-year=18.2%, 5-year=0%). These results indicated that PIHP achieved a 5-year survival rate of approximately 23.5% in patients with multiple advanced hepatocellular carcinoma in the absence of distant organ metastases and marked vascular invasion, and yielded complete long-term remission in a subset of these patients.

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