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One hundred nine patients with hepatocellular carcinoma were treated with intravenous (IV) Adriamycin (doxorubicin). Cumulative survival rate was 34% at 6 months and 13% at 1 year. Survival was positively related to a good performance status and to alpha-fetoprotein less than 50 ng/ml, not influenced by hepatitis B surface antigen (HBsAg) and by presence of clear cells in the tumor. Partial response (alpha-fetoprotein decrease by greater than or equal to 50% of the initial value) was observed in 10 patients and complete response in 1 patient, always within the fourth dose, with a 10% response rate. Twenty of 75 symptomatic patients (27%) achieved improvement in performance and/or pain reduction. Withdrawal of treatment became necessary for side effects in six patients. In conclusion, IV Adriamycin in hepatocellular carcinoma has only limited efficacy. Because of its early activity, treatment can be stopped after three doses if there is no evidence of response.

A total of 67 cirrhotic patients with clinically suspected neoplastic degeneration and low alpha-fetoprotein levels were assessed prospectively with ultrasound and gold (198Au) scintigraphy. Ultrasound showed space-occupying lesions in 22 of the 24 patients who had a final diagnosis of hepatocellular carcinoma (HCC) (sensitivity, 95.8%) and excluded the presence of HCC in 37 of the 43 patients with cirrhosis only (specificity, 86.0%; efficiency, 90.8%). Scintigraphy demonstrated a cold defect in 22 of the 24 patients who had a final diagnosis of HCC (sensitivity, 95.8%) and excluded the presence of HCC in 22 of the 43 patients with cirrhosis only (specificity, 51.1%; efficiency, 69.8%). It was concluded that the most accurate screening plain in cirrhotic patients suspected of having HCC with alpha-fetoprotein values below 500 mg/ml would consist of ultrasonography followed, as clinically indicated, by ultrasonographic or laparoscopic guided biopsy.