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Influence of prognostic groupings and treatment results in the management of unresectable hepatoma: experience with Cisplatinum-based chemoradiotherapy in 76 patients.

Publication ,  Journal Article
Abrams, RA; Cardinale, RM; Enger, C; Haulk, TL; Hurwitz, H; Osterman, F; Sitzmann, JV
Published in: Int J Radiat Oncol Biol Phys
December 1, 1997

PURPOSE: Internationally, hepatoma is a common cause of cancer death. Although the only curative therapy is surgical, most tumors are unresectable and cause death. The value of nonsurgical, antineoplastic therapy for such tumors is controversial. This study was undertaken to extend and confirm promising, but preliminary, treatment observations in the unresectable context. METHODS AND MATERIALS: From 1988 to 1993, 76 patients with unresectable, biopsy proven, hepatoma underwent uniform pretreatment assessment followed by induction therapy with external beam radiotherapy (21 Gy/7 fractions/10 days) and intravenous Cisplatinum, 50 mg/m2. One month later patients began monthly intrahepatic artery Cisplatinum, 50 mg/m2. Clinical course and treatment outcomes were correlated with previously published prognostic factors and groupings (Nomura et al., Okuda et al., Stillwagon, et al.). RESULTS: The toxicity of this therapy was modest and nonlimiting. Twenty-four patients (32%) progressed during induction and prior to receiving two cycles of intrahepatic artery Cisplatinum without evidence of benefit. Patients showing this early progression were more likely to be Stillwagon unfavorable than favorable (p = 0.013), Okuda Stage II than Stage I (p = 0.024), and slightly but not statistically more likely to be alpha-fetoprotein positive than alpha-fetoprotein negative (p = 0.098). The overall objective response rate was 43% (38% among AFP positive and 62% among AFP negative patients) (p = 0.15). Although 21 patients had evidence of extra hepatic metastases, survival for these patients did not differ from patients without metastases (p = 0.09) and patients with extra hepatic metastases were just as likely to show intrahepatic response (p = 0.84). CONCLUSION: The chemoradiotherapy program utilized produced objective response and minimal toxicity. One-third of patients progressed rapidly in spite of treatment. Among the remaining patients, response occurred frequently. This treatment appears to represent an important therapeutic option for many, but not all, patients with unresectable hepatoma.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

December 1, 1997

Volume

39

Issue

5

Start / End Page

1077 / 1085

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Prognosis
  • Oncology & Carcinogenesis
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Liver Neoplasms
  • Infusions, Intra-Arterial
  • Humans
 

Citation

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Abrams, R. A., Cardinale, R. M., Enger, C., Haulk, T. L., Hurwitz, H., Osterman, F., & Sitzmann, J. V. (1997). Influence of prognostic groupings and treatment results in the management of unresectable hepatoma: experience with Cisplatinum-based chemoradiotherapy in 76 patients. Int J Radiat Oncol Biol Phys, 39(5), 1077–1085. https://doi.org/10.1016/s0360-3016(97)00389-1
Abrams, R. A., R. M. Cardinale, C. Enger, T. L. Haulk, H. Hurwitz, F. Osterman, and J. V. Sitzmann. “Influence of prognostic groupings and treatment results in the management of unresectable hepatoma: experience with Cisplatinum-based chemoradiotherapy in 76 patients.Int J Radiat Oncol Biol Phys 39, no. 5 (December 1, 1997): 1077–85. https://doi.org/10.1016/s0360-3016(97)00389-1.
Abrams RA, Cardinale RM, Enger C, Haulk TL, Hurwitz H, Osterman F, et al. Influence of prognostic groupings and treatment results in the management of unresectable hepatoma: experience with Cisplatinum-based chemoradiotherapy in 76 patients. Int J Radiat Oncol Biol Phys. 1997 Dec 1;39(5):1077–85.
Abrams, R. A., et al. “Influence of prognostic groupings and treatment results in the management of unresectable hepatoma: experience with Cisplatinum-based chemoradiotherapy in 76 patients.Int J Radiat Oncol Biol Phys, vol. 39, no. 5, Dec. 1997, pp. 1077–85. Pubmed, doi:10.1016/s0360-3016(97)00389-1.
Abrams RA, Cardinale RM, Enger C, Haulk TL, Hurwitz H, Osterman F, Sitzmann JV. Influence of prognostic groupings and treatment results in the management of unresectable hepatoma: experience with Cisplatinum-based chemoradiotherapy in 76 patients. Int J Radiat Oncol Biol Phys. 1997 Dec 1;39(5):1077–1085.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

December 1, 1997

Volume

39

Issue

5

Start / End Page

1077 / 1085

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Prognosis
  • Oncology & Carcinogenesis
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Liver Neoplasms
  • Infusions, Intra-Arterial
  • Humans