CLINICAL STUDY Hepatic Arterial Infusion of Oxaliplatin, Fluorouracil, and Leucovorin in Hepatocellular Cancer with Extrahepatic Spread Ning Lyu, MD, Yanan Kong, MD, PhD, Tao Pan, MD, Luwen Mu, MD, Shaolong Li, MD, Yaru Liu, MD, Haijing Deng, MD, Jibin Li, PhD, Ming Shi, MD, PhD, Li Xu, MD, PhD, Rongping Guo, MD, PhD, Minshan Chen, MD, PhD, Peihong Wu, MD, and Ming Zhao, MD, PhD ABSTRACT Purpose: To compare treatment with hepatic arterial infusion of chemotherapy (HAIC) in patients with advanced hepatocellular carcinoma (HCC) with both extrahepatic spread (EHS) and intrahepatic tumor and patients with intrahepatic tumor only. Materials and Methods: This single-center retrospective study comprised 116 patients with advanced HCC with both intrahepatic tumor and EHS (EHS group; n ¼ 50) or with intrahepatic tumor only (non-EHS group; n ¼ 66) treated with HAIC including oxaliplatin, fluorouracil, and leucovorin between June 2014 and July 2016. Overall survival (OS) and radiologic responses to treatment were determined and compared between the 2 groups. Results: Both the objective response rate and the clinical benefit rate were higher in the non-EHS group than in the EHS group (37.9% vs 16% objective response rate, P ¼ .010; 81.8% vs 62% clinical benefit rate, P ¼ .017). Median OS was not statistically different between the 2 groups (14.8 months vs 9.8 months, P ¼ .068). Subgroup analysis of OS found that patients with lung metastases survived for a shorter time (OS 7 months) than patients with other metastatic sites (P ¼ .003) and patients free of metastases (P ¼ .001). Conclusions: HAIC is a potential treatment option for advanced HCC with limited extrahepatic metastases in a population with hepatitis B virus infection. ABBREVIATIONS CI ¼ confidence interval, CR ¼ complete response, EHS ¼ extrahepatic spread, FU ¼ fluorouracil, HAI ¼ hepatic arterial infusion, HAIC ¼ hepatic arterial infusion chemotherapy, HBV ¼ hepatitis B virus, HCC ¼ hepatocellular carcinoma, HR ¼ hazard ratio, LV ¼ leucovorin, MVI ¼ macrovascular invasion, ORR ¼ objective response rate, OS ¼ overall survival, OXA ¼ oxaliplatin, PR ¼ partial response, SD ¼ stable disease Advanced hepatocellular carcinoma (HCC), or Barcelona Clinic Liver Cancer stage C HCC, is defined as tumors with macrovascular invasion (MVI), extrahepatic spread (EHS), mild cancer-related symptoms (Eastern Cooperative Oncology Group performance status grades 1–2), or a combination of these (1). Approximately 25%–70% of pa- tients with HCC have advanced-stage disease at initial diagnosis, which is poorly controllable with a dismal From the Departments of Minimally Invasive Interventional Radiology (N.L., S.L., H.D., P.W., M.Z.) and Medical Imaging (Y.L., P.W.), Center of Medical Imaging and Interventional Radiology, Department of Breast Oncology (Y.K.), State Key Laboratory of Oncology in South China, Department of Clinical Research (J.L.), and Department of Hepatobiliary Oncology (M.S., L.X., R.G., M.C.), Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong 510060, China; and Department of Vascular Inter- ventional Radiology (T.P., L.M.), Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. Received April 25, 2018; final revision received August 30, 2018; accepted September 5, 2018. Address correspondence to M.Z.; E-mail: zhaoming@sysucc.org.cn N.L. and Y.K. contributed equally. None of the authors have identified a conflict of interest. Appendix A and Table E1 can be found by accessing the online version of this article on www.jvir.org and clicking on the Supplemental Material tab. © SIR, 2018 J Vasc Interv Radiol 2019; 30:349–357 https://doi.org/10.1016/j.jvir.2018.09.004