Biliary sclerosis after hepatic arterial infusion pump chemotherapy for patients with colorectal cancer liver metastasis: Incidence, clinical features, and risk factors Journal Article

  

Authors:	Ito, K.; Ito, H.; Kemeny, N. E.; Gonen, M.; Allen, P. J.; Paty, P. B.; Fong, Y.; DeMatteo, R. P.; Blumgart, L. H.; Jarnagin, W. R.; D'Angelica, M. I.
Article Title:	Biliary sclerosis after hepatic arterial infusion pump chemotherapy for patients with colorectal cancer liver metastasis: Incidence, clinical features, and risk factors
Abstract:	Background. Hepatic arterial infusion pump chemotherapy (HAIPC) contributes to the prolonged survival of selected patients with colorectal cancer liver metastases (CRCLM). The most clinically important adverse event after HAIPC with floxuridine (FUDR) is biliary sclerosis (BS). Little is known about the etiology of BS. Methods. HAIPC was administered to 475 consecutive patients who received HAIPC on prospective protocols from 1991 to 2008. The incidence, clinical features, variables related to demographics, comorbidity, medical history, CRCLM, surgery, chemotherapy, and laboratory data were reviewed. An analysis of factors potentially associated with BS, defined as a biliary stricture related to HAIPC requiring stent placement, was performed. Results. The incidence of BS was 5.5% (16 of 293) in patients receiving HAIPC as an adjuvant therapy after hepatectomy, and 2% (2 of 100) in patients receiving HAIPC with FUDR for unresectable disease. The common hepatic duct was the site most frequently affected (87.5%). In patients receiving adjuvant HAIPC, BS was associated with abnormal postoperative flow scans (18.8% vs. 1.8%, P = 0.006), postoperative infectious complications (50.0% vs. 14.8%, P = 0.002), and larger dose/cycle/weight of FUDR (2.6 vs. 2.0 mg/cycle/kg, P = 0.025) than patients without BS. No patient died directly of BS. Median survival was not compromised by the development of BS (BS vs. non-BS: 61.0 months [range 6.2-171.6 months] vs. 47.2 months [range 2.4-200.8 months], P = 0.316, respectively). Conclusions. BS is an uncommon complication after HAIPC and does not compromise survival if adequately salvaged by stenting or dilatation. Surgical complications as well as type and dose of intra-arterial chemotherapy may contribute to the development of BS. © Society of Surgical Oncology 2011.
Keywords:	adult; cancer survival; aged; aged, 80 and over; middle aged; cancer surgery; survival rate; young adult; major clinical study; clinical feature; bevacizumab; fluorouracil; cancer combination chemotherapy; liver neoplasms; colorectal cancer; cohort studies; incidence; risk factor; irinotecan; postoperative complication; colorectal neoplasms; liver metastasis; folinic acid; comorbidity; infusions, intra-arterial; postoperative infection; hepatectomy; hyperbilirubinemia; inoperable cancer; mitomycin; oxaliplatin; floxuridine; biliary tract diseases; ligation; sclerosis; dilatation; stents; biliary tract disease; infusion pump; causality; hepatic duct; biliary tract sclerosis
Journal Title:	Annals of Surgical Oncology
Volume:	19
Issue:	5
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2012-05-01
Start Page:	1609
End Page:	1617
Language:	English
DOI:	10.1245/s10434-011-2102-8
PROVIDER:	scopus
PUBMED:	21989666
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84862509821&partnerID=40&md5=8c8792870064d9969672cc8cb53d4b85
Notes:	--- - "Export Date: 2 July 2012" - "CODEN: ASONF" - "Source: Scopus"

https://synapse.mskcc.org/synapse/works/has_related_data_chk/29124