Abstract
The most common site of metastasis from colorectal carcinoma is the liver. Surgical resection of hepatic metastases can result in long-term survival. The majority of patients have unresectable disease, however, and even if hepatic metastases are resected, most patients will still experience relapse, often in the liver. Hepatic arterial infusion (HAI) of chemotherapy allows high concentrations of a drug to be delivered directly to hepatic metastases with minimal systemic toxicity. HAI therapy has been used to treat unresectable isolated hepatic metastases of colorectal cancer and has also been investigated as adjuvant therapy after resection. This review examines the role of HAI as therapy for both unresectable and resectable hepatic metastases.
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References and Recommended Reading
Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2007. CA Cancer J Clin 2007, 57:43–66.
Stangl R, Altendorf-Hofmann A, Charnely RM, et al.: Factors influencing the natural history of colorectal liver metastases. Lancet 1994, 343:1405–1410.
Biasco G, Derenzini E, Grazi GL, et al.: Treatment of hepatic metastases from colorectal cancer: Many doubts, some certainties. Cancer Treatment Rev 2006, 32:214–228.
Tomlinson JS, Jarnaqin WR, DeMatteo RP, et al.: Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 2007, 25:4575–4580.
Cohen AD, Kemeny NE: An update on hepatic arterial infusion chemotherapy for colorectal cancer. Oncologist 2003, 8:553–566.
Sullivan RD, Norcross JW, Watkins E Jr: Chemotherapy of metastatic liver cancer by prolonged hepatic artery infusion. N Engl J Med 1964, 270:321–327.
Breedis C, Young G: The blood supply of neoplasms in the liver. Am J Pathol 1954, 30:969–977.
Collins, JM: Pharmacologic rationale for regional drug delivery. J Clin Oncol 1984, 2:498–504.
Ensminger WD, Gyves JW: Clinical pharmacology of hepatic arterial infusion chemotherapy. Semin Oncol 1983, 10:176–182.
Curley SA, Chase JL, Roh MS, et al.: Technical considerations and complication associated with the placement of 180 implantable hepatic arterial infusion devices. Surgery 1993, 114:928–935.
Heinrich S, Petrowsky H, Schwinnen I, et al.: Technical complications of continuous intra-arterial chemotherapy with 5-fluorodeoxyuridine and 5-fluorouracil for colorectal liver metastases. Surgery 2003, 133:40–48.
Campbell KA, Burns RC, Sitzmann JV, et al.: Regional chemotherapy devices: effect of experience and anatomy on complications. J Clin Oncol 1993, 11:822–826.
Skitzki JJ, Chang AE: Hepatic artery chemotherapy for colorectal liver metastases: technical consideration and review of clinical trials. Surg Oncol 2002, 11:123–135.
Allen-Mersh TG, Earlam S, Fordy C, et al.: Quality of life and survival with continuous hepatic-artery floxuridine infusion for colorectal liver metastases. Lancet 1994, 344:1255–1260.
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, 10:1112–1118.
Hohn D, Melnick J, Stagg R, et al.: Biliary sclerosis in patients receiving hepatic arterial infusions of floxuridine. J Clin Oncol 1985, 3:98–102.
Kemeny NE, Niedzwiecki D, Hollis DR, et al.: Hepatic arterial infusion versus systemic therapy for hepatic metastases from colorectal cancer: a randomized trial of efficacy, quality of life and molecular markers. J Clin Oncol 2006, 24:1395–1403.
Harmantas A, Rotstein LE, Langer B: Regional versus systemic chemotherapy in the treatment of colorectal carcinoma metastatic to the liver. Is there a survival difference? Meta-analysis of the published literature. Cancer 1996, 78:1639–1645.
Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal carcinoma. Meta-analysis group in cancer. J Natl Cancer Inst 1996, 88:252–258.
Doria MI Jr, Shepard KV, Levin B, Riddell RH: Liver pathology following hepatic arterial infusion chemotherapy. Hepatic toxicity with FUDR. Cancer 1986, 58:855–861.
Kemeny N, Seiter K, Niedzwiecki D, et al.: A randomized trial of intrahepatic infusion of fluorodeoxyuridine with dexamethasone versus fluorodeoxyuridine alone in the treatment of metastatic colorectal cancer Cancer 1992, 69:327–334.
Stagg RJ, Venook AP, Chase JL, et al.: Alternating hepatic intra-arterial floxuridine and fluorouracil: a less toxic regimen for treatment of liver metastases from colorectal cancer. J Natl Cancer Inst 1991, 83:423–428.
Kemeny N, Seiter K, Conti JA, et al.: Hepatic arterial floxuridine and leucovorin for unresectable liver metastases from colorectal carcinoma. New dose schedules and survival update. Cancer 1994, 73:1134–1142.
Link KH, Sunelaitis E, Kornmann M, et al.: Regional chemotherapy of nonresectable colorectal liver metastases with mitoxantrone, 5-fluorouracil, folinic acid, and mitomycin C may prolong survival. Cancer 2001, 92:2746–2753.
Ducreux M, Ychou M, Laplanche A, et al.: Hepatic arterial oxaliplatin infusion plus intravenous chemotherapy in colorectal cancer with inoperable hepatic metastases: a trial of the gastrointestinal group of the Federation Nationale des Centres de Lutte Contre le Cancer. J Clin Oncol 2005, 23:4881–4887.
Del Freo A, Fiorentini G, Sanguinetti F, et al.: Hepatic arterial chemotherapy with oxaliplatin, folinic acid and 5-fluorouracil in pre-treated patients with liver metastases from colorectal cancer. In Vivo 2006, 20:743–746.
Boige V, Malka D, Elias D, et al.: Hepatic arterial infusion of oxaliplatin and intravenous LV5FU2 in unresectable liver metastases from colorectal cancer after systemic chemotherapy failure. Ann Surg Oncol 2008, 15:219–226.
Fiorentini G, Rossi S, Dentico P, et al.: Irinotecan hepatic arterial infusion chemotherapy for hepatic metastases from colorectal cancer: a phase II clinical study. Tumori 2003, 89:382–384.
Safi F, Birtner R, Roscher R, et al.: Regional chemotherapy for hepatic metastases of colorectal carcinoma (continuous intraarterial versus continuous intraarterial/intravenous therapy). Results of a controlled clinical trial. Cancer 1989, 64:379–387.
Fiorentini G, Cantore M, Rossi S, et al.: Hepatic arterial chemotherapy in combination with systemic chemotherapy compared with hepatic arterial chemotherapy alone for liver metastases from colorectal cancer: results of a multicentric randomized study. In Vivo 2006, 20:707–709.
Kemeny N, Jarnagin W, Paty P, et al.: Phase I trial of systemic oxaliplatin combination chemotherapy with hepatic arterial infusion in patients with unresectable liver metastases from colorectal cancer. J Clin Oncol 2005, 23:4888–4896.
Leonard GD, Brenner B, Kemeny NE: Neoadjuvant chemotherapy before liver resection for patients with unresectable liver metastases from colorectal carcinoma. J Clin Oncol 2005, 23:2038–2048.
Tournigand C, André T, Achille E, et al.: FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 2004, 22:229–237.
Kemeny MM, Adak S, Gray B, et al.: Combined-modality treatment for resectable metastatic colorectal carcinoma to the liver: surgical resection of hepatic metastases in combination with continuous infusion of chemotherapy—an intergroup study. J Clin Oncol 2002, 20:1499–1505.
Kemeny N, Huang Y, Cohen AM, et al.: Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med 1999, 341:2039–2048.
Kemeny N, Gonen M: Hepatic arterial infusion after liver resection [letter]. N Engl J Med 2005, 352:734–735.
Lorenz M, Müller HH, Schramm H, et al.: Randomized trial of surgery versus surgery followed by adjuvant hepatic arterial infusion with 5-fluorouracial and folinic acid for liver metastases of colorectal cancer. German Cooperative on Liver Metastases (Arbeitsgruppe Lebermetastasen). Ann Surg 1998, 228:756–762.
Kemeny N, Jarnagin W, Gonen M, et al.: Phase I/II study of hepatic arterial therapy with floxuridine and dexamethasone in combination with intravenous irinotecan as adjuvant treatment after resection of hepatic metastases from colorectal cancer. J Clin Oncol 2003, 21:3303–3309.
Nelson R, Freels S: Hepatic artery adjuvant chemotherapy for patients having resection or ablation of colorectal cancer metastatic to the liver. Cochrane Database Syst Rev 2006, CD003770.
Gray B, Van Hazel G, Hope M, et al.: Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 2001, 12:1711–1720.
Elaraj DM, Alexander HR: Current role of hepatic artery infusion and isolated liver perfusion for the treatment of colorectal cancer liver metastases. Cancer J 2004, 10:128–138.
Bartlett DL, Libutti SK, Figg WD, et al.: Isolated hepatic perfusion for unresectable hepatic metastases from colorectal cancer. Surgery 2001, 129:176–187.
Bartlett DL, Berlin J, Lauwers GY, et al.: Chemotherapy and regional therapy of hepatic colorectal metastases: expert consensus statement. J Surg Oncol 2006, 13:1284–1292.
Kerr DJ, McArdle CS, Ledermann J, et al.: Intrahepatic arterial versus intravenous fluorouracil and folinic acid for colorectal cancer liver metastases: a multicentre randomized trial. Lancet 2003, 361:368–373.
Lorenz M, Müller HH: Randomized, multicenter trial of fluorouracil plus leucovorin administered either via hepatic arterial or intravenous infusion versus fluorodeoxyuridine administered via hepatic arterial infusion in patients with nonresectable liver metastases from colorectal carcinoma. J Clin Oncol 2000, 18:243–254.
Martin JK, O’Connell MJ, Wieand HS, et al.: Intra-arterial floxuridine vs systemic fluorouracil for hepatic metastases from colorectal cancer. A randomized trial. Arch Surg 1990, 125:1022–1027.
Wagman LD, Kemeny MM, Leong L, et al.: A prospective, randomized evaluation of the treatment of colorectal cancer metastatic to the liver. J Clin Oncol 1990, 8:1885–1893.
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 1989, 7:1646–1654.
Chang AE, Schneider PD, Sugarbaker PH, et al.: A prospective randomized trial of regional versus systemic continuous 5-fluorodeoxyuridine chemotherapy in the treatment of colorectal liver metastases. Ann Surg 1987, 206:685–693.
Kemeny N, Daly J, Reichman B, et al.: Intrahepatic or systemic infusion of fluorodeoxyuridine in patients with liver metastases from colorectal carcinoma. A randomized trial. Ann Intern Med 1987, 107:459–465.
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Choo, SP., Venook, A.P. Hepatic artery infusion in the treatment of colorectal cancer metastases. Curr colorectal cancer rep 4, 106–113 (2008). https://doi.org/10.1007/s11888-008-0018-x
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DOI: https://doi.org/10.1007/s11888-008-0018-x