Liver Cancer (cont.)
Chemotherapy
Systemic (entire body) chemotherapy
The most commonly used systemic chemotherapeutic agents are doxorubicin
(Adriamycin) and 5-fluorouracil (5 FU). These drugs are used together or in
combination with new experimental agents. These drugs are quite toxic and
results have been disappointing. A few studies suggest some benefit with
tamoxifen (Nolvadex) but just as many studies show no advantage. Octreotide
(Sandostatin) given as an injection was shown in one study to slow down the
progression of large liver cancer tumors, but so far, no other studies have confirmed
this benefit.
Hepatic arterial infusion of chemotherapy
The normal liver gets its blood supply from two sources; the portal vein
(about 70%) and the hepatic artery (30%). However, liver cancer gets its blood
exclusively from the hepatic artery. Making use of this fact, investigators have
delivered chemotherapy agents selectively through the hepatic artery directly to
the tumor. The theoretical advantage is that higher concentrations of the agents
can be delivered to the tumors without subjecting the patients to the systemic
toxicity of the agents.
In reality, however, much of the chemotherapeutic agents does end up in the
rest of the body. Therefore, selective intra-arterial chemotherapy can cause the
usual systemic (body-wide) side effects. In addition, this treatment can result
in some regional side effects, such as inflammation of the gallbladder
(cholecystitis), intestinal and stomach ulcers, and inflammation of the pancreas
(pancreatitis). Liver cancer patients with advanced cirrhosis may develop liver failure
after this treatment. Well then, what is the benefit of intra-arterial
chemotherapy? The bottom line is that fewer than 50% of patients will experience
a reduction in tumor size.
An interventional radiologist (one who does therapeutic procedures) usually
carries out this procedure. The radiologist must work closely with an oncologist
(cancer specialist), who determines the amount of chemotherapy that the patient
receives at each session. Some patients may undergo repeat sessions at 6 to 12
week intervals. This procedure is done with the help of fluoroscopy (type of
x-ray) imaging. A catheter (long, narrow tube) is inserted into the femoral
artery in the groin and is threaded into the aorta (the main artery of the
body). From the aorta, the catheter is advanced into the hepatic artery. Once
the branches of the hepatic artery that feed the liver cancer are identified,
the chemotherapy is infused. The whole procedure takes one to two hours, and
then the catheter is removed.
The patient generally stays in the hospital overnight for observation. A
sandbag is placed over the groin to compress the area where the catheter was
inserted into the femoral artery. The nurses periodically check for signs of
bleeding from the femoral artery puncture. They also check for the pulse in the
foot on the side of the catheter insertion to be sure that the femoral artery is
not blocked as a result of the procedure. (Blockage would be signaled by the
absence of a pulse.)
Generally, the liver tests increase (get worse) during the two to three days
after the procedure. This worsening of the liver tests is actually due to death
of the tumor (and some non-tumor) cells. The patient may experience some
post-procedure abdominal pain and low-grade fever. However, severe abdominal
pain and vomiting suggest that a more serious complication has developed.
Imaging studies of the liver are repeated in six to 12 weeks to assess the size of
the tumor in response to the treatment. For more, please read the Chemotherapy
article.
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