Effect of arterial administration of a high-molecular weight antitumor agent, styrene maleic acid neocarzinostatin, in embolization-resistant liver cancer

Abstract

Background. Hepatocellular carcinoma often shows a resistance to transcatheter arterial embolization in the course of therapy repetition.

Methods. Forty-four of 103 consecutive patients with hepatocellular carcinoma showing a resistance to repeated embolization therapy were treated with intra-arterial injection of the high-molecular weight antitumor agent styrene-maleic acid neocarzinostatin (Zinostatin) mixed with Lipiodol (group A). The remaining 59 patients received repeated embolization with epirubicin given in the same way (group B).

Results. In group A, computerized tomography scans 3 months after the therapy showed "complete" accumulation of Lipiodol in 2 patients (4.5%), and "good" accumulation (50%–99%) in 11 (25.0%); 10%–49% accumulation was shown in 12 patients (41.9%), and less than 10% in 19 patients (32.6%). In group B, 1 patient (1.7%) showed complete accumulation, 4 (6.8%) showed "good" accumulation, 10 (16.9%) showed 10%–49% accumulation, and 44 (74.6%) showed less than 10%. Multivariate logistic regression analysis showed that factors affecting Lipiodol accumulation after therapy included tumor multiplicity (P < 0.0001), use of Zinostatin (P = 0.010), and decompensation of cirrhosis (P = 0.049). In the 44 patients with Zinostatin injection, tumor size was the only factor affecting Lipiodol accumulation. Survival rates in groups A and B were 70.4% and 45.8%, respectively, at the end of the first year, 36.8% and 17.3% at the end of the second year, and 24.5% and 13.0% at the end of the third year (P = 0.0087).

Conclusion. Intra-arterial Zinostatin injection therapy increased the Lipiodol accumulation rate and the survival rate in patients with embolization-resistant HCC, and the best candidates for the treatment were patients with smaller liver cancer of 50 mm.