Arterial infusion chemotherapy has become one of the major treatments for malignant tumors. Since 1988, we have attempted repeated arterial infusion of anticancer drugs using an implantable drug delivery system in 68 patients who had inoperable hepatocellular carcinoma (HCC). Most of our patients could not undergo transcatheter arterial embolization (TAE) because of extreme tumor extension and/or accompanying advanced liver cirrhosis. In most patients we implanted a 5-F catheter via the femoral artery nonsurgically and connected it to a subcutaneously implanted drug delivery system without any difficulty. The treatment consisted of weekly or biweekly intrahepatic one-shot administration of anticancer drugs. As one therapeutic regimen, epirubicin was given alone. Other regimens consisted of combined chemotherapy using two or more of the following drugs: mitomycin C, Adriamycin, 5-fluorouracil, cisplatin, and epirubicin. In some cases, these drugs mixed with Lipiodol were given for targeting and slow release in the liver. The response rate (CR+PR) of the cases was 25.0%. The median survival period was 389.9 days. The 6-month, 1-year, and 2-year survival rates were 75%, 45%, and 17%, respectively. There was no severe side effect or complication except arterial occlusion that precluded further infusion chemotherapy. We think that the implantable drug delivery system will contribute not only to improved therapeutic efficacy for inoperable HCC but also to an improved quality of life for the patients.

Conventional bone scintigraphy is often inconclusive in detecting bone metastases of hepatocellular carcinoma, suggesting the necessity of alternative scintigraphic agents. In this study, the diagnostic value of I-123 IMP scintigraphy was evaluated in 8 patients with 12 pelvic bone metastases from hepatocellular carcinoma, then compared with Ga-67 scintigraphy. Eleven of 12 lesions (91.7%) were detected by I-123 IMP scintigraphy; Ga-67 scintigraphy visualized 8 lesions (66.7%) in the same patient population. I-123 IMP scintigraphy is useful for detecting pelvic bone metastases of hepatocellular carcinoma with less physiologic accumulation in the intestine as compared with Ga-67 scintigraphy.