Oral Chemotherapy Versus Supportive Therapy In The Treatment Of Unresectable Hepatocellular Carcinoma

Background Hepatocellular carcinoma, a malignant tumour of liver is one of the most common cancers worldwide. All India Institute Of Medical Sciences (AIIMS) being a tertiary care hospital receives about two to three cases of Hepatocellular carcinoma (HCC) each day in the investigators Gastroenterology out patient department. Most of these patients present late when the disease is already advanced and no curative therapies can be offered. At this stage, palliative therapy forms the mainstay of treatment. This includes transarterial chemoembolization (TACE) or Oral chemotherapy. Many patients also have involvement of branches of portal vein, which further limit therapeutic options. According to Barcelona Clinic Liver Cancer (BCLC) staging of liver cancer, involvement of portal vein precludes any standard form of therapy. These patients have been recommended for experimental therapies. Various forms of chemotherapy have been tried this group of patients. HCC is a vascular tumour and thalidomide is an anti-angiogenic drug and inhibits vascularity and has been used in the treatment of HCC. Capecitabine is a novel drug, which gives continuous delivery of 5-FU and has been used in patients with HCC and has been found to be safe.

Sex

All

Minimum age

12 Years

Maximum age

70 Years

Inclusion Criteria:

* Patients above 12 years of age with
* ECOG performance status (PST) score of 3 or above
* Underlying Child's A and B cirrhosis
* More than 50% involvement of liver by tumor
* Thrombosed main portal vein
* HV/IVC thrombosis
* Extra hepatic disease
* Metastatic disease
* Informed written consent of patient

Exclusion Criteria:

* History of drug allergy
* Co-morbid illness like coronary artery disease, congestive heart failure, chronic renal failure etc
* Pregnancy
* Outstation patients from distant areas not in a position to follow up