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A new therapy utilizing imaging techniques facilitates precise placement of chemotherapy directly into liver cancer cells, as reported at the 85th Annual Meeting of the Radiological Society of North America.

The liver is the largest organ in the body and is responsible for over 500 functions, including the secretion of glucose, proteins, vitamins and fats; the production of bile; the processing of hemoglobin and the detoxification of numerous substances. Primary liver cancer, sometimes called hepatocellular carcinoma, starts in the cells of the liver and can spread through blood or lymph vessels to different parts of the body. Currently, the only curative treatment option for liver cancer is surgical removal of the cancer (resection). However, many patients are not able to undergo surgical resection due to the large size of their cancer.

One type of treatment strategy used in some patients with inoperable liver cancer involves the administration of chemotherapy drugs directly into the main artery (hepatic artery) that constantly delivers blood to the liver (intra-arterial). Intra-arterial delivery may augment the anti-cancer effects of chemotherapy beyond the effects offered by systemic (full body) delivery through a few mechanisms: 1) the chemotherapy agent does not become diluted by mixing with the rest of the blood from the body prior to reaching the cancer, 2) the chemotherapy agent is not broken down in the body through biochemical processes prior to reaching the cancer, 3) larger amounts of the chemotherapy agent can reach the cancer with fewer associated systemic side effects.

A novel approach to intra-arterial chemotherapy administration involves the use of ultrasound and computerized tomography (CT) to guide the placement of the chemotherapy injections in the liver. Ultrasound allows “real-time” visualization of the insertion of the chemotherapy needles, enabling physicians precise placement into the cancer. In addition, this type of treatment has shown to be effective in cancers up to 7 cm in size.

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Researchers from Johns Hopkins University Medical Center recently conducted a clinical trial evaluating image-guided intra-arterial chemotherapy with cisplatin in 38 patients with inoperable liver cancer. A 50% reduction in cancer size was demonstrated in 21 patients. Nine patients experienced a complete cancer disappearance. Survival rates were comparable to those of patients with operable cancer. Side effects were reported to be mild to moderate.

Results from this clinical trial suggest that image-guided intra-arterial chemotherapy for inoperable liver cancer may produce significant anti-cancer responses and improve survival for these patients. In addition, researchers believe this therapy may prove beneficial for patients awaiting a liver transplant. Patients with inoperable liver cancer may wish to speak with their physician about image-guided intra-arterial chemotherapy or the participation in a clinical trial utilizing other promising treatment strategies.

(Proceedings from the 85th Annual Meeting of the Radiological Society of North America, Chicago, IL, December, 2000)