Development of a new multi-modality therapy for far advanced hepatocellular carcinoma : a combined therapy of a new percutaneous local tumor ablation and a chemotherapy using subcutaneously embedded port for arterial infusion or gene therapy

本研究的目的是开发一种新的多模态治疗方法，用于治疗由于癌症广泛扩散而仅通过经导管动脉栓塞或支持治疗而无法治愈的中晚期肝癌。我们希望开发一种新的经皮局部肿瘤消融术与皮下嵌入式动脉输液港化疗或基因治疗相结合的治疗方法。关于新的经皮肿瘤消融术的开发，自1999年2月推出以来，我们共进行了400例射频消融术（RFA）。射频消融术12分钟即可获得直径3cm的坏死区。在大多数情况下，一次或两次治疗足以实现病变的完全坏死，并具有安全边界，从而缩短住院时间。我们认为，在不久的将来，95%以上的经皮肿瘤消融治疗病例将接受RFA治疗。因此，我们希望获得更多的专业知识来执行RFA。关于化疗的优化，我们使用皮下嵌入式动脉输液港进行了“低剂量FP”化疗，并一直在分析数据，以评估影响化疗疗效的因素。最终目标是在治疗前预测治疗效果。要做到这一点，我们将在未来使用DNA提示。我们还使用了一种新的化疗方案5-FU和干扰素。我们将在更多的病例中使用该方案并评估其疗效。我们已经使用裸鼠来检查基因治疗的有效性和安全性，以便将其引入临床试验。然而，我们尚未取得令人满意的结果。

The aim of this study was to develop a new multi-modality therapy for far advanced hepatocellular carcinoma, which had been treated non-curatively only by transcatheter arterial embolization or supportive therapy because of wide spread of the cancer. We wanted to develop a combined therapy of a new percutaneous local tumor ablation and a chemotherapy using subcutaneously embedded port for arterial infusion or gene therapy.With regard to development of a new percutaneous tumor ablation, we have performed radio-frequency ablation(RFA)on a total of 400 cases since we introduced it in February 1999. In RFA, we can surely obtain a necrotic area of 3 cm in diameter by a 12-minute ablation. In most cases, one or two treatment sessions are enough to achieve a complete necrosis of the lesion with a safety margin, which results in a shorter hospitalization. We think more than 95% of cases treated by percutaneous tumor ablation will be treated by RFA in the near future. Thus we would like to gain more know-how to perform RFA.With regard to optimization of chemotherapy, we performed "low dose FP" chemotherapy using subcutaneously embedded port for arterial infusion and have been analyzing data to evaluate factors which contributed the chemotherapeutic efficacy. The final goal is to predict therapeutic efficacy before the treatment. To do this, we would use DNA tips in the future. We have also used a new chemotherapeutic regimen of 5-FU and interferon. We will use the regimen on more cases and evaluate its efficacy.We have used nude mice to examine usefulness and safety of a gene therapy in order to introduce it to a clinical trial. However, we have not achieved satisfactory results yet.