ArticleQuantitative imaging in medicine and surgery2025
Modified hepatic arterial infusion chemotherapy protocol for reducing perioperative pain and anesthetic consumption in patients with hepatocellular carcinoma.
Article in Quantitative imaging in medicine and surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Hepatic arterial infusion chemotherapy (HAIC) with the FOLFOX (folinic acid + fluorouracil + oxaliplatin) regimen has emerged as a crucial treatment for advanced hepatocellular carcinoma (HCC), but oxaliplatin-induced neuropathic pain significantly reduces patients' quality of life. This study investigated the impact of modified HAIC procedures on perioperative pain levels and analgesic requirements in patients with HCC. Methods: This single-institution retrospective study analyzed 180 patients with HCC undergoing HAIC. Patients were divided into three groups: Group A (n=40), which received the standard FOLFOX-HAIC regimen; Group B (n=74), which received a reverse sequence FOLFOX-HAIC (REFOLFOX-HAIC), with oxaliplatin administered after fluorouracil and leucovorin; and Group C (n=67), which received a direct intraoperative infusion of oxaliplatin with FOLFOX-HAIC (OxDirect-FOLFOX-HAIC). The primary endpoints were the intraoperative and 24-hour postoperative analgesic utilization score and visual analogue scale (VAS) pain scores. Secondary outcomes included tumor response and safety. Results: Both modified protocols demonstrated superior pain management. Compared to the standard regimen (Group A), both Group B (REFOLFOX-HAIC) and Group C (OxDirect-FOLFOX-HAIC) showed significantly lower analgesic utilization scores (P=0.021 and P=0.027, respectively). Similarly, VAS pain scores were significantly reduced in Group B and Group C (P=0.019 and P=0.039, respectively). Importantly, these modifications did not compromise therapeutic efficacy; after 3 months, there were no statistically significant differences between Groups A-C in terms of objective response rates (15.00% Conclusions: The REFOLFOX-HAIC and OxDirect-FOLFOX-HAIC procedures significantly reduced perioperative pain and the need for analgesics in patients with HCC as compared to the conventional FOLFOX-HAIC protocol, without compromising short-term tumor control or safety.
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