Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for liver cancer is usually put into the body by inserting a needle into a vein orartery. This type of chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the liver. In another type of chemotherapy called regional chemotherapy, a small pump containing drugs is placed in the body. The pump puts drugs directly into the blood vessels that go to the tumor.

Chemotherapy has a traditional response rate with both primary and metastatic cancers in the 20 percent range. A response is a situation in which there is either cancer shrinkage for a period of a few months or failure of the cancer to progress for a similar time. While doctors do not minimize the possibility of this treatment modality to provide real benefit, chemotherapy is definite a fall back position and will only be offered in combination with other treatment methods, when other methods have failed, when the situation is advanced beyond the point in which other treatment methods can help. This can also be applied at times in advanced situations but ones in which there is hope to downstage the patient to the point that he or she will be a candidate for other therapies

Chemoembolization of the hepatic artery involves blocking the hepatic artery and then injecting chemotherapy drugs between the blockage and the liver, using the liver's arteries to deliver the chemotherapy throughout the liver. The most commonly used systemic chemotherapeutic agents are doxorubicin (Adriamycin) and 5-fluorouracil (5 FU). These drugs can be 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 the drug tamoxifen (Nolvadex) but just as many studies show no advantage.

An interventional radiologist 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 six to twelve 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.

The liver tests 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 a more serious complication

Chemotherapy can also be administered directly into the liver artery. Liver tumors derive their blood supply from the hepatic artery, and intra-arterial administration will expose the tumor to high doses of chemotherapy (100 - 400 times higher values than systemic infusion).This increased drug exposure achieves significant tumor shrinkage in 50 - 70% of patients. The 2 most commonly used drugs are 5 FU and FUDR. Administering combinations of drugs can improve the chance of tumor shrinkage