Transcatheter Arterial Chemotherapy with Miriplatin for Hepatocellular Carcinoma Patients with Chronic Renal Failure: Report of Three Cases
A 72-year-old man with HCC, liver cirrhosis, and diabetic nephropathy had undergone RFA four times and TACE three times over 5 years. As shown in , a computed tomography (CT) scan of the liver revealed multiple HCCs (tumor size, 15 to 34 mm; tumor number, three; stage, T2N0M0). The serum creatinine level was 2.3 mg/dL, and the estimated glomerular filtration rate (GFR) was 21.9 mL/min ().\nThe patient was hydrated through a peripheral line. The femoral artery was catheterized under local anesthesia, and catheter was inserted superselectively into the hepatic artery that supplied the target tumor, for injection of the miriplatin/lipiodol suspension and 1 mm gelatin particles (1 mm-Gelpart; Nippon Kayaku, Tokyo, Japan). Miriplatin/lipiodol suspension was administrated slowly under careful fluoroscopic guidance. The dose of miriplatin/lipiodol was determined according to tumor size and the degree of liver dysfunction. The patient received TACE with miriplatin (miriplatin 50 mg, lipiodol 2.5 mL, and 1 mm-Gelpart were injected from both the right and left hepatic arteries). Therapy was well tolerated, and the patient's weight and serum creatinine level remained stable after treatment (). Major side effects included grade 1 fever, elevated blood glucose, and grade 1 nausea, which all resolved within 1 week (the National Cancer Institute's Common Terminology Criteria for Adverse Events [CTCAE] version 4.0). Treatment efficacy was assessed 1 month after treatment. Partial response (modified response evaluation criteria in solid tumors, mRECIST) was achieved in all target lesions.\nThe patient was received two times TACE with miriplatin at intervals of 4 months after the first administration (second and third dosage of miriplatin were 120 mg and dosage of lipiodol were 6 mL). The patient's weight and serum creatinine level still remained stable after repeat injection of miriplatin (serum creatinine level was 2.2 mg/dL after third TACE with miriplatin). Stable disease (mRECIST) was achieved in all target lesions after third TACE with miriplatin.