Surgery After Downstaging of Unresectable Hepatic Tumors With Intra-Arterial Chemotherapy Authors
Received: 04 January 2000 Accepted: 21 April 2000 DOI:
Cite this article as: Meric, F., Patt, Y.Z., Curley, S.A. et al. Ann Surg Oncol (2000) 7: 490. doi:10.1007/s10434-000-0490-2 Abstract Background: This retrospective study was performed to assess the outcome among patients who underwent hepatic resection or tumor ablation after hepatic artery infusion (HAI) therapy downstaged previously unresectable hepatocellular carcinoma (HCC) or liver metastases from colorectal cancer (CRC). Methods: Between 1983 and 1998, 25 patients with HCC and 383 patients with hepatic CRC metastases were treated with HAI therapy for unresectable liver disease. We retrospectively reviewed the records of 26 (6%) of these patients who underwent subsequent surgical exploration for tumor resection or ablation. Results: At a median of 9 months (range 7–12 months) after HAI treatment, four patients (16%) with HCC underwent exploratory surgery; two underwent resection with negative margins, and the other two were given radiofrequency ablation (RFA) because of underlying cirrhosis. At a median postoperative follow-up of 16 months (range 6–48 months), all four patients were alive with no evidence of disease. At a median of 14.5 months (range 8–24 months) after HAI therapy, 22 patients with hepatic CRC metastases underwent exploratory surgery; 10 underwent resection, 6 underwent resection and RFA or cryotherapy, and 2 underwent RFA only. At a median follow-up of 17 months, 15 (83%) of the 18 patients with CRC who had received surgical treatment had developed recurrent disease; the other 3 died of other causes (1 of postoperative complications) within 7 months of the surgery. One patient in whom disease recurred underwent a second resection and was disease-free at 1 year follow-up. Conclusions: Hepatic resection or ablation after tumor downstaging with HAI therapy is a viable option for patients with unresectable HCC. However, given the high rate of recurrence of metastases from CRC, hepatic resection or ablation after downstaging with HAI should be used with caution. Key Words Hepatic artery infusion Chemotherapy Colorectal cancer Metastases Hepatocellular cancer
Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, New Orleans, Louisiana, March 16–19, 2000.
Okuda K, Ohtsuki T, Obata H, et al. Natural history of hepatocellular carcinoma and prognosis in relation to treatment: study of 850 patients.
Kemeny NE, Schneider AM. Regional treatment of hepatic metastases and hepatocellular carcinoma.
Curr Probl Cancer
Wingo PA, Tong T, Bolden S. Cancer statistics, 1995.
CA Cancer J Clin
Weiss L, Grundmann E, Torhorst J, et al. Haematogenous metastatic patterns in colonic carcinoma: An analysis of 1541 necropsies.
Chang AE, Schneider PD, Sugarbaker PH, Simpson C, Culnane M, Steinberg SM. A prospective randomized trial of regional versus systemic continuous 5-fluorodeoxyuridine chemotherapy in the treatment of colorectal liver metastases.
Kemeny N, Daly J, Reichman B. Intrahepatic or systemic infusion of floxuridine in patients with liver metastases from colorectal carcinoma: a randomized trial.
Ann Intern Med
Hohn DC, Stagg RJ, Friedman MA, et al. A randomized trial of continuous intravenous versus hepatic intraarterial floxuridine in patients with colorectal cancer metastatic to the liver: The Northern California Oncology Group trial.
J Clin Oncol
Meta-Analysis Group in Cancer. Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer.
J Natl Cancer Inst 1996;88:252–258.
Vauthey JN, Marsh RW, Cendan JC, Chu N-M, Copeland EM. Arterial therapy of hepatic colorectal metastases.
Br J Surg
Rougier P, Laplanche A, Huguier M, et al. Hepatic arterial infusion of floxuridine in patients with liver metastases from colorectal carcinoma: long-term results of a prospective randomized trial.
J Clin Oncol 1992;7:1112–1118.
Allen-Mersh TG, Earlam S, Fordy C, Abrams K, Houghton J. Quality of life and survival with continuous hepatic-artery floxuridine infusion for colorectal liver metastases.
Ekberg H, Tranberg KG, Andersson R, Lundstedt C, Hagerstrand I, Ranstam J, Bengmark S. Determinants of survival in liver resection for colorectal secondaries.
Br J Surg
Curley SA, Izzo F, Delrio P, Ellis LM, et al. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: Results in 123 patients.
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.
Breedis C, Young C. The blood supply of neoplasms in the liver.
Am J Pathol 1954;10:176–182.
Ensminger WD, Gyves JW. Clinical pharmacology of hepatic arterial chemotherapy.
Vauthey JN, Klimstra D, Franceschi D, et al. Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma.
Am J Surg
Patt YZ, Claghorn L, Charnsangavej C, Soski M, Cleary K, Mavlit GM. Hepatocellular carcinoma: a retrospective analysis of treatments to manage disease confined to the liver.
Sitzmann JV, Order SE, Klein JL, Leichner PK, Fishman EK, Smith GW. Conversion by new treatment modalities of nonresectable to resectable hepatocellular cancer.
J Clin Oncol
Sitzmann JV, Abrams R. Improved survival for hepatocellular cancer with combination surgery and multimodality treatment.
Tang Z-Y, Yu Y-Q, Zhou X-D, et al. Cytoreduction and sequential resection: a hope for resectable primary liver cancer.
J Surg Oncol
Tang Z-Y, Yu Y-Q, Zhou X-D, et al. Cytoreduction and sequential resection for surgically verified unresectable hepatocellular carcinoma: evaluation with analysis of 72 patients.
World J Surg
Fuhrman GM, Curley SA, Hohn DC, Roh MS. Improved survival after resection of colorectal liver metastases.
Ann Surg Oncol
Steele Jr G, Ravikumar TS. Resection of hepatic metastases from colorectal cancer.
Patt YZ, Hoque A, Lozano R, et al. Phase II trial of hepatic arterial infusion of fluorouracil and recombinant human interferon alfa-2b for liver metastases of colorectal cancer refractory to systemic fluorouracil and leucovorin.
J Clin Oncol
Rifkin MD, Posato FE, Branch HM, et al. Intraoperative ultrasound of the liver, an important adjunctive tool for decision making in the operating room.
Olsen AK. Intraoperative ultrasonography and the detection of liver metastases in patients with colorectal cancer.
Br J Surg
Nagasne N, Koboyashi M, Iwaki A, et al. Effect of 5-fluorouracil on liver regeneration and metabolism after partial hepatectomy in rats.
Didolkar MS, Fitzpatrick JL, Elias EG, et al. Risk factors before hepatectomy, hepatic function after hepatectomy and computed tomographic changes as indicators of mortality from hepatic failure.
Surg Gyn Oncol 1989;169:17–26.
Elias D, Lasser P, Rougier P, Ducreux M, Bognel C, Roche A. Frequency, technical aspects, results and indications of major hepatectomy after prolonged intra-arterial hepatic chemotherapy for initially unresectable hepatic tumors.
J Am Coll Surg
Fong Y, Cohen AM, Fortner JG, Enker WE, et al. Liver resection for colorectal metastases.
J Clin Oncol
Bismuth H, Adam R, Levi F, et al. Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy.
Ann Surg 1996;4:509–522.
Levi F, Metzger G, Massari C, Milano G. Oxaliplatin: pharmacokinetics and chronopharmacological aspects.
Focan C, Levi F, Kreutz F, et al. Continuous delivery of venous 5-fluorouracil and arterial 5-fluorodeoxyuridine for hepatic metastases from colorectal cancer: feasibility and tolerance in a randomized phase II trial comparing flat versus chronomodulated infusion.
Levi F, Giacchetti S, Adam R, Zidani R, Metzger G, Misset JL. Chronomodulation of chemotherapy against metastatic colorectal cancer. International Organization for Cancer Chronotherapy.
Eur J Cancer
PubMed Copyright information
© The Society of Surgical Oncology, Inc. 2000