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Hepatic Arterial Infusion in Combination with Modern Systemic Chemotherapy is Associated with Improved Survival Compared with Modern Systemic Chemotherapy Alone in Patients with Isolated Unresectable Colorectal Liver Metastases: A Case–Control Study

Annals of Surgical Oncology volume 24, pages 150–158 (2017)Cite this article

Abstract

Background

In the era of effective modern systemic chemotherapy (CT), the role of hepatic arterial infusion of fluoxuridine (HAI-FUDR) in the treatment of isolated unresectable colorectal liver metastasis (IU-CRCLM) remains controversial. This study aimed to compare the overall survival (OS) of HAI-FUDR in combination with modern systemic CT versus modern systemic CT alone in patients with IU-CRCLM.

Methods

This was a case–control study of IU-CRCLM patients who underwent HAI + modern systemic CT or modern systemic CT alone. Modern systemic CT was defined as the use of multidrug regimens containing oxaliplatin and/or irinotecan ± biologics.

Results

Overall, 86 patients met the inclusion criteria (n = 40 for the HAI + CT group, and n = 46 for the CT-alone group). Both groups were similar in demographics, primary and stage IV tumor characteristics, and treatment-related variables (carcinoembryonic antigen, use of biologic agents, total number of lines of systemic CT administered) (all p > 0.05). Additionally, both groups were comparable with respect to liver tumor burden [median number of lesions (13.5 vs. 15), percentage of liver tumor replacement (37.5 vs. 40 %), and size of largest lesion] (all p > 0.05). Median OS in the HAI + CT group was 32.8 months compared with 15.3 months in the CT-alone group (p < 0.0001). Multivariate analysis revealed HAI + CT (hazard ratio 0.4, 95 % confidence interval 0.21–0.72; p = 0.003), Eastern Cooperative Oncology Group status, and receipt of increasing number of lines of systemic CT to be independent predictors of survival.

Conclusions

In this case–control study of patients with IU-CRCLM, HAI in combination with CT was associated with improved OS when compared with modern systemic CT alone.

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Conflict of Interest

Mashaal Dhir, Heather L. Jones, Yongli Shuai, Amber K. Clifford, Samantha Perkins, Jennifer Steve, Melissa E. Hogg, M. Haroon A. Choudry, James F. Pingpank, Matthew P. Holtzman, Herbert J. Zeh III, Nathan Bahary, David L. Bartlett, and Amer H. Zureikat have no conflicts of interest involving this work.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Mashaal Dhir MD, Heather L. Jones MPA-C, Amber K. Clifford MPA-C, Samantha Perkins MPA-C, Jennifer Steve BS, Melissa E. Hogg MD, M. Haroon A. Choudry MD, James F. Pingpank MD, Matthew P. Holtzman MD, Herbert J. Zeh III MD, David L. Bartlett MD & Amer H. Zureikat MD

  2. Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA

    Yongli Shuai MS

  3. Department of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Nathan Bahary MD, PhD

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  1. Mashaal Dhir MD
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Correspondence to Amer H. Zureikat MD.

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Dhir, M., Jones, H.L., Shuai, Y. et al. Hepatic Arterial Infusion in Combination with Modern Systemic Chemotherapy is Associated with Improved Survival Compared with Modern Systemic Chemotherapy Alone in Patients with Isolated Unresectable Colorectal Liver Metastases: A Case–Control Study. Ann Surg Oncol 24, 150–158 (2017). https://doi.org/10.1245/s10434-016-5418-6

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