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Hepatic arterial chemotherapy of liver metastases from colorectal cancer: Treatment results, limitations and future aspects

Regionale Chemotherapie bei Lebermetastasen kolorektaler Karzinome: Therapieergebnisse, Limitationen und zukünftige Aspekte

  • Main Topics: Current Strategies In The Treatment Of Colorectal Cancer Liver Metastases
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Summary

Background: For more than three decades, hepatic arterial chemotherapy (HAI) has been used in the treatment of liver metastases from colorectal cancer. This approach achieves significantly higher concentrations of various cytotoxic agents within the hepatic parenchyma and tumour tissue while minimizing systemic toxicity.

Methods: In this article, we briefly review and discuss the results of recently published clinical studies of HAI, limitations of the technique, possible options for improvement, as well as future aspects of liver-directed therapy.

Results: In the clinical setting, there is no doubt that higher objective response rates can be achieved compared to systemic delivery of the same cytotoxic drugs. However, HAI requires laparotomy, is not without risks and side effects, and recent results of randomized trials have raised certain doubts concerning its role in the palliative first-line and adjuvant treatment setting.

Conclusions: One of the major drawbacks of HAI is its inability to prevent or delay the development of extrahepatic disease. A number of recently published studies have demonstrated, however, that HAI can be safely combined with intravenous irinotecan or oxaliplatin. HAI continues to represent a valuable alternative therapy in patients with liver-only metastases failing previous systemic fluoropyrimidine-based chemotherapy.

Zusammenfassung

Grundlagen: Die regionale Chemotherapie via A. hepatica wird seit mehr als drei Jahrzehnten zur Behandlung von Lebermetastasen kolorektaler Karzinome verwendet. Durch diesen Therapieansatz lassen sich signifikant höhere intrahepatische/intratumorale Konzentrationen verschiedener Zytostatika realisieren, wobei die systemische Toxizität verringert erscheint.

Methodik: In diesem Übersichtsartikel werden die Ergebnisse rezent publizierter Studien des regionalen Therapiekonzeptes zusammengefasst dargestellt und prinzipielle Limitationen, mögliche Problemlösungen sowie zukünftige Aspekte der intrahepatischen Chemotherapie diskutiert.

Ergebnisse: Aufgrund klinischer Daten besteht kein Zweifel daran, daß die regionale Chemotherapie zu höheren Remissionsraten führt als die systemische Gabe der jeweiligen Substanzen. Dennoch impliziert diese Technik die Notwendigkeit einer Laparotomie; die Behandlung ist ferner mit gewissen Risiken und Nebenwirkungen behaftet und die Ergebnisse jüngst publizierter randomisierter Studien haben bezüglich des tatsächlichen therapeutischen Stellenwertes sowohl im palliativen als auch im adjuvanten Setting, gewisse Zweifel ergeben.

Schlußfolgerungen: Ein Nachteil der regionalen Chemotherapie stellt die Tatsache dar, dass das Auftreten extrahepatischer Metastasen nicht verhindert werden kann. Allerdings haben einige jüngst publizierte Phase-I/II-Studien gezeigt, dass die lokale Therapie mit systemischen Gaben von Irinotecan oder Oxaliplatin kombiniert werden kann. Die intraartierielle Chemotherapie stellt unverändert eine wertvolle Therapiealternative bei Patienten mit selektiver Lebermetastasierung dar, die auf eine auf 5-FU basierende Erstlinientherapie nicht angesprochen haben.

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Authors and Affiliations

  1. Division of Oncology, Department of Internal Medicine I, Währinger Gürtel 18-20, A-1090, Vienna

    Birgit Schüll & W. Scheithauer M.D.

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Schüll, B., Scheithauer, W. Hepatic arterial chemotherapy of liver metastases from colorectal cancer: Treatment results, limitations and future aspects. Eur. Surg. 34, 344–346 (2002). https://doi.org/10.1046/j.1563-2563.2002.02080.x

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  • DOI: https://doi.org/10.1046/j.1563-2563.2002.02080.x

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