Conversion to resectability using hepatic artery infusion plus systemic chemotherapy for the treatment of unresectable liver metastases from colorectal carcinoma Journal Article

   

Authors:	Kemeny, N. E.; Huitzil-Melendez, F. D.; Capanu, M.; Paty, P. B.; Fong, Y.; Schwartz, L. H.; Jarnagin, W. R.; Patel, D.; D'Angelica, M.
Article Title:	Conversion to resectability using hepatic artery infusion plus systemic chemotherapy for the treatment of unresectable liver metastases from colorectal carcinoma
Abstract:	Purpose: To determine the conversion to resectability in patients with unresectable liver metastases from colorectal cancer treated with hepatic arterial infusion (HAI) plus systemic oxaliplatin and irinotecan (CPT-11). Patients and Methods: Forty-nine patients with unresectable liver metastases (53% previously treated with chemotherapy) were enrolled onto a phase I protocol with HAI floxuridine and dexamethasone plus systemic chemotherapy with oxaliplatin and irinotecan. Results: Ninety-two percent of the 49 patients had complete (8%) or partial (84%) response, and 23 (47%) of the 49 patients were able to undergo resection in a group of patients with extensive disease (73% with > five liver lesions, 98% with bilobar disease, 86% with ≥ six segments involved). For chemotherapy-naïve and previously treated patients, the median survival from the start of HAI therapy was 50.8 and 35 months, respectively. The only baseline variable significantly associated with a higher resection rate was female sex. Variables reflecting extensive anatomic disease, such as number of lesions or number of vessels involved, were not significantly associated with the probability of resection. Conclusion: The combination of regional HAI floxuridine/dexamethasone and systemic oxaliplatin and irinotecan is an effective regimen for the treatment of patients with unresectable liver metastases from colorectal cancer, demonstrating a 47% conversion to resection (57% in chemotherapy-naïve patients). Future randomized trials should compare HAI plus systemic chemotherapy with systemic therapy alone to assess the additional value of HAI therapy in converting patients with hepatic metastases to resectability. © 2009 by American Society of Clinical Oncology.
Keywords:	adult; cancer chemotherapy; cancer survival; treatment outcome; treatment response; aged; cancer surgery; major clinical study; overall survival; clinical trial; neutropenia; diarrhea; multimodality cancer therapy; side effect; antineoplastic agents; liver neoplasms; combined modality therapy; neurotoxicity; antineoplastic agent; disease association; metastasis; progression free survival; camptothecin; dexamethasone; pathology; irinotecan; aspartate aminotransferase blood level; colorectal carcinoma; drug dose escalation; postoperative complication; colorectal neoplasms; liver metastasis; colorectal tumor; liver tumor; drug derivative; heparin; intraarterial drug administration; infusions, intra-arterial; sex difference; anatomy; alkaline phosphatase blood level; platinum complex; oxaliplatin; hematoma; floxuridine; organoplatinum compounds; bilirubin blood level; hepatic artery; liver injury; segmental mastectomy; mastectomy, segmental
Journal Title:	Journal of Clinical Oncology
Volume:	27
Issue:	21
ISSN:	0732-183X
Publisher:	American Society of Clinical Oncology
Date Published:	2009-07-20
Start Page:	3465
End Page:	3471
Language:	English
DOI:	10.1200/jco.2008.20.1301
PUBMED:	19470932
PROVIDER:	scopus
PMCID:	PMC3646304
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-70249149719&partnerID=40&md5=a6ec15af3e58f912ce479a6e84c3f8bd
Notes:	--- - "Cited By (since 1996): 14" - "Export Date: 30 November 2010" - "CODEN: JCOND" - "Source: Scopus"