Regional / Intra-Arterial Chemotherapy

Regional chemotherapy uses drugs to treat the cancer, and is a non-surgical treatment for Hepatocellular Carcinoma. It takes advantage of direct access to the blood vessels to provide the arterial blood supply to the liver.

Using steerable micro-catheters, the intervention radiologist is able to gain access to the arterial supply of the liver and then more selectively of the cancer in the liver. Getting the catheter appropriately positioned generally takes less than 30 minutes under light sedation. Treatment may be delivered over an additional 30 to 60 minutes from one or more selected locations.

All catheters are removed at the end of the procedure, and the arterial penetration site is observed for 6 hours. Regional treatment may be repeated as necessary at 4 to 8 week intervals. Now used worldwide, the steerable micro-catheter was invented at the Norris Cancer Center at the University of Southern California for this application.

The treatment may be chemotherapy infusion, or chemoembolization, where the chemotherapy drug is mixed with particles that block the blood vessels. At USC the initial treatment delivered is usually infusion with cisplatin and mitomycin rather than chemoembolization, because of a better side-effect profile and better preservation of blood vessels to allow re-treatment.

The regional chemotherapy program is highly individualized, reflecting issues related to size and extent of the cancer, underlying liver disease, and the observed effectiveness in each patient:

• Definitive treatment by itself
• Cancer size reduction followed by needle ablation by radio-frequency heating or by cryosurgery
• Cancer control while awaiting liver transplant
• Preventative selective treatment of liver after resection