Implantation of a drug delivery system during surgery for patients with primary hepatocarcinoma

BACKGROUND: Postoperative regional chemotherapy is one of the most effective methods to decrease the recurrent rate and improve the prognosis of primary hepatocarcinoma (PHC). This study was undertaken to assess the optimal pathway to implant the drug delivery system (DDS) in the different ways of resecting PHC so as to offer a valuable reference to clinical implantation of the DDS. METHODS: One hundred and ninety cases were divided into two groups according to whether the tumors were resected completely (A) or not (B). Groups A and B were subdivided into three groups a, b and c according to the pathway selected for DDS implantation. The patients in subgroup a received DDS implantation through both the hepatic artery and portal vein (A+P-implanted group), the patients in subgroup b received DDS implantation through the portal vein (P-implanted group), and the patients in subgroup c received DDS implantation through the hepatic artery (A-implanted group). RESULTS: The 1- and 3-year recurrent rates of subgroup c in group A were higher than those of subgroup b, and there was no significant difference between subgroups a and b. Compared with subgroups a and c, the 1- and 3-year survival rates of subgroup b were similar to those of group a but higher than those of group c. The 1- and 3-year survival rates between subgroups a and b in group B were significantly different. The prognosis of subgroup c was lower than that of subgroup a and no significant difference was observed between subgroups b and c. CONCLUSIONS: The DDS should be implanted into the portal vein when PHC is resected completely. It may be better to implant it into both portal vein and hepatic artery if the tumor cannot be completely resected.

Detection of autoantibodies in the serum of primary hepatocarcinoma patients

Objective: To study the significance of detecting au-toantibodies in primary hepatocarcinoma(PHC) pa-tients.Methods: Autoantibodies were detected by indirect im-munofluorescence assay. Antigens and antibodies ofHBV were determined by enzymeimmune assay. Antibodyto HCV IgG was detected by enzyme-linked immunoab-sorbent assay.Results: The positive rate of autoantibody was 27.3%(38/139) in 139 PHC patients. The main type of au-toantibodies in PHC was anti-nuclear antibody (36/38, 94.7%); others included anti-smooth muscle anti-body(2/38, 5.3% ), anti-mitochondria antibody(1/38, 2.6%), anti-midbody antibody (1/38, 2.6%), andanti-liver cell membrane antibody(2/38, 5.3%).Conclusions: Detecting autoantibodies in PHC patientsis of significance in studying the mechanism of au-toimmune reaction and etiology in PHC. The diversityof autoantibodies might result from a wide variety ofetiological factors involved in PHC development, andfrom a wide variety of overexpressed or mutated pro-teins involved in repeated cycles of necrosis and regen-eration in hepatocarcinoma development.

Clinical Observation on Primary Hepatocarcinoma Treatedby Arterial Perfusion with Cinobufotalin and Chemicals

Objective: To find effective treatment with less side-effect for hepatocarcinoma.Methods: Seventy patients were divided into two groups, treated with cinobufotalin plus chemicals and chemicals alone by arterial perfusion respectively. The symptoms, hematological picture, tumor size and viral marker of patients were observed and compared.Results: The treatment with cinobufotalin plus chemicals was more effective than that of chemicals alone in body weight increasing, pain relieving, liver function recovering and virus marker negative inversing.Conclusion: Cinobufotalin could improve the effect of chemo-embolization therapy of hepatocarcinoma.

Clinical Study on Treatment of Primary Hepatocellular Carcinoma by Shenqi Mixture (参芪合剂) Combined with Microwave Coagulation

Objective: To observe the short￣term efficacy and safety of Shenqi mixture (参芪合剂, SQM) combined with microwave coagulation in treating primary hepatocellular carcinoma (HCC).Methods: Seventy-two patients with primary HCC of stage Ⅱ-Ⅲ, Karnofsky scoring ≥50 scores and predicted survival period ≥3 months were selected and randomly assigned into two groups, the treated group and the control group, 36 in each. Microwave therapy was applied to both groups by double leads, 60 W, 800 sec once a week for two weeks. To the treated group, SQM was given additionally through oral intake of 20 ml, three times a day for 1 month. The changes in tumor size, main symptoms, serum level of alpha-fetoprotein (AFP), immune function and adverse reaction were observed after treatment and the immune parameters of the patients were compared with 30 healthy persons in the normal control group. Results: (1) In the SQM treated group, after treatment 3 patients got completely remitted (CR), 24 partial remitted (PR), 4 unchanged (NC) and 5 progressively deteriorated (PD), the effective rate being 75.00%; while in the control group, 1 got CR, 19 PR, 9 NC and 7 PD, the effective rate being 55.56%. Comparison of the effective rate between the two groups showed significant difference (P<0.05). (2) AFP level decreased after treatment in both groups, but the decrement in the treated group was significantly higher than that in the control group (P<0.01). (3) After treatment, in the treated group, CD3+, CD4+, CD4+/CD8+ and NK activity were improved, Karnofsky scores increased and liver function bettered, with these improvements significantly superior to those in the control group (P<0.01). (4) The improvement in symptoms such as hepatic region pain, fever, weakness, poor appetite and jaundice in the treated group after treatment was also superior to that in the control group (P<0.01). (5)The 12-month, 18-month and 24-month survival rates were higher and the recurrence rate was lower in the treated group than those in the control group, showing significant difference (P<0.05). Conclusion: Combined therapy with SQM and microwave coagulation could not only kill the tumor and residue tumor cells to prevent recurrence, but also enhance the cellular immunity of organism. It is one of the effective therapies for patients with middle-advanced hepatocarcinoma, who have lost the chance of surgical operation. It could improve clinical symptoms, elevate the quality of life, prolong the survival period of patients, but shows no evident adverse reaction.

Study on Treatment of 313 Patients with Mid-Late Primary Hepatocarcinoma by Integrated Traditional Chinese and Western Medicine

To evaluate objectively the clinical effect and superiority of integrated traditional Chinese and western medicine (TCM-WM) in treating mid-late hepatocarcinoma.Methods: The 313 patients observed were divided randomly into 3 groups, Group Ⅰ, Ⅱ and Ⅲ, they were treated with protocol TACE, protocol PEI and comprehensive conservative therapy respectively. Each group was sub-divided into 2 sub-groups, sub-group A and B, and sub-group As was treated coordinately with different Chinese herbal medicine, Sisheng Decoction to sub-group ⅠA and ⅡA, and cinobufacin or norcantharidin to ⅢA respectively. And Chinese herbal medicine prescribed according to TCM Syndrome Differentiation was also given to all the sub-group As.Results: The integrated therapy showed significant effect in treating mid-late hepatocarcinoma, as it could improve significantly the clinical symptoms and signs, raise the quality of life and prolong the survival time in patients. When TCM-WM cooperated with TACE, it could alleviate the toxic effect and enhance the therapeutic effect of chemotherapy. There was statistical significant difference in clinical effect between the TCM-WM treated groups and the western medicine treated groups (P<0.05).Conclusion: TCM-WM therapy displays not only the action in enhancing the short-term therapeutic effect of treatment in treating mid-late hepatocarcinoma but also shows significant effect in enhancing long-term therapeutic effect and prolonging survival time in patients. It is worth further spreading.

Study on Treatment of Primary Hepatic Carcinoma by Arterial Perfusion Embolization with Zedoary Turmeric Oil

To evaluate the effect, side-effect and prospect of hepatic arterial perfusion embolization (HAPE) with Zedoary turmeric oil (ZTO) in treating primary hepatic carcinoma (PHC).Methods: Clinical study was carried out by administration of 1-3 ml ZTO through arterial catheter to induce embolism in 32 patients of PHC, and compared with 32 patients treated by hepatic arterial perfusion embolization with chemical agents (HAPE-C) in the control group. The Chinese herbal medicine was given orally to both groups according to Syndrome Differentiation of TCM. In the experimental study, transplantation hepatic carcinoma model was established in 40 rats. They were randomly divided into the treated group and the control group, 20 in each group, and were perfused with 10 mg/kg ZTO and 0.2-0.3 ml normal saline respectively to observe the effect of treatment.Results: The effect of treatment in the ZTO group was CR in 1 case and PR in 13 cases, the total effective rate being 43.75%, with AFP negative reversed in 7 cases, titer decreased in 7; while in the control group it was PR in 10 cases, the total effective rate being 31.25%, AFP negative reversed in 5, titer decreased in 2, and the difference of therapeutic effect between the two groups was insignificant (P>0.05). The post-perfusion thrombotic syndrome occurrence, with the symptoms of fever, abdominal pain, vomiting, etc. in the two groups was similar, but no bone marrow inhibition occurred in the ZTO group, which was different from the control group (P<0.01, P<0.05). The mean survival time, median survival time, 1-, 2-, 3- and 4-year survival rate in the ZTO group was 13.84 months, 10 months, 37.5%, 18.87%, 9.70% and 6.4% respectively, and in the control group, 8.03 months, 6 months, 15.6%, 6.27%, 0% and 0% respectively, the mean survival time, median survival time and 1-year survival rate in the ZTO group were significantly superior to those in the control group (P<0.05). Experimental study showed that the effect in the treated group was better than that in the control group in tumor growth inhibition with the tumor growth rate as 10.8±4.5%% vs 20.6±12.7%, P<0.05, tumor necrosis degree (P<0.01) and survival time prolonged (14.8±3.4 days vs 11.7±1.9 days, P<0.05).Conclusion: HAPE-ZTO in treating PHC showed the therapeutic effect similar to that of HAPE-C, but superior to the latter in survival time prolongation and bone marrow inhibition.