Hepatic arterial chemotherapy and occlusion for palliation of primary hepatocellular and unknown primary neoplasms in the liver

Eighteen patients with malignant liver disease were treated with hepatic arterial infusion (HAI) of floxuridine (FUDR), Adriamycin (doxorubicin), and mitomycin C (FUDRAM). Twelve of the patients had primary hepatocellular carcinoma and six had metastatic liver carcinoma originating from an unknown primary site. One complete remission and seven partial remissions (greater than or equal to 50% reduction in tumor size) were observed among 12 hepatocellular cancer patients, while only one partial remission was achieved among six patients with unknown primary liver neoplasms. When arterial occlusion was added to HAI of FUDRAM, a prolongation of median survival to 14 months as opposed to six months in patients with an intact arterial tree was observed (P = 0.02). Arterial occlusion had its effect on survival particularly among patients who failed to respond to HAI of FUDRAM. Thus, among nonresponding patients, the addition of arterial occlusion resulted in a median survival of 10.5 months while median survival in those without arterial occlusion was six months (P = 0.08). With procedure-related morbidity being minimal, we conclude that arterially administered FUDRAM offers a notable palliation to patients with primary hepatocellular carcinoma. In patients with unknown primary liver neoplasms and those with hepatocellular cancer who fail HAI of FUDRAM, arterial occlusion can offer additional palliation.