Comparison of adjuvant systemic chemotherapy with or without hepatic arterial infusional chemotherapy after hepatic resection for metastatic colorectal cancer Journal Article

  

Authors:	House, M. G.; Kemeny, N. E.; Gonen, M.; Fong, Y.; Allen, P. J.; Paty, P. B.; DeMatteo, R. P.; Blumgart, L. H.; Jarnagin, W. R.; D'Angelica, M. I.
Article Title:	Comparison of adjuvant systemic chemotherapy with or without hepatic arterial infusional chemotherapy after hepatic resection for metastatic colorectal cancer
Abstract:	BACKGROUND:: The potential benefit of adjuvant hepatic arterial infusional floxuridine (HAI-FUDR) in addition to modern systemic chemotherapy using oxaliplatin or irinotecan remains unknown for patients with resected liver-confined colorectal metastases (CRLM). The principle aim of this study was to compare outcomes in patients receiving modern systemic chemotherapy with or without HAI-FUDR. METHODS:: Between 2000 and 2005, 125 patients underwent resection of CRLM followed by adjuvant HAI-FUDR plus dexamethasone (Dex) and concurrent systemic chemotherapy including oxaliplatin or irinotecan. These patients were compared retrospectively to 125 consecutive patients who received modern systemic chemotherapy alone after liver resection. RESULTS:: The median follow-up for all patients was 43 months. There were no differences in clinical risk score, disease-free interval, size of largest CRLM, number of CRLM, or prehepatectomy CEA level between the 2 groups. Adjuvant HAI-FUDR was associated with an improved overall and liver recurrence-free survival (liver RFS) and disease-specific survival (DSS). For the adjuvant HAI-FUDR group, the 5-year liver RFS, overall RFS, and DSS were 75%, 48%, and 79%, respectively, compared to 55%, 25%, and 55% for the systemic alone group (P < 0.01). On multivariate analysis, adjuvant treatment including HAI-FUDR was independently associated with improved liver RFS (HR = 0.34), overall RFS (HR = 0.65), and DSS (HR = 0.39), P < 0.01. CONCLUSIONS:: Adjuvant HAI-FUDR combined with modern systemic chemotherapy is independently associated with improved survival compared to adjuvant systemic chemotherapy alone. A randomized clinical trial between these 2 regimens is justified. Copyright C © 2011 by Lippincott Williams & Wilkins.
Keywords:	adult; cancer chemotherapy; cancer survival; controlled study; aged; aged, 80 and over; disease-free survival; middle aged; major clinical study; overall survival; fluorouracil; multimodality cancer therapy; liver neoplasms; cancer adjuvant therapy; comparative study; disease free survival; chemotherapy, adjuvant; combined modality therapy; follow up; follow-up studies; preoperative evaluation; colorectal cancer; tumor localization; tumor volume; antineoplastic combined chemotherapy protocols; morbidity; camptothecin; dexamethasone; risk assessment; irinotecan; colorectal neoplasms; liver metastasis; folinic acid; infusions, intra-arterial; liver resection; disease free interval; hepatectomy; oxaliplatin; floxuridine; organoplatinum compounds; computed tomographic angiography; hepatic arterial infusional floxuridine
Journal Title:	Annals of Surgery
Volume:	254
Issue:	6
ISSN:	0003-4932
Publisher:	Lippincott Williams & Wilkins
Date Published:	2011-12-01
Start Page:	851
End Page:	856
Language:	English
DOI:	10.1097/SLA.0b013e31822f4f88
PROVIDER:	scopus
PUBMED:	21975318
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-81855185584&partnerID=40&md5=97a95c0555a506e944e5b33a56dd81eb
Notes:	--- - "Cited By (since 1996): 1" - "Export Date: 3 January 2012" - "CODEN: ANSUA" - "Source: Scopus"

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