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Adjuvant Hepatic Arterial Infusion Therapy

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Colorectal Cancer Liver Metastases

Abstract

Colorectal cancer represents a significant global health burden, with the liver as the most common site of metastases. In patients with metastatic disease, 60% will develop liver metastases, and this is a major cause of morbidity and mortality. Historically, liver metastatic colorectal cancer carried a poor prognosis. With modern systemic chemotherapy regimens and use of liver-directed therapies, great advances have been made.

Surgery offers the best chance of cure, but even in those patients who are able to undergo hepatic resection, the recurrence rate is 70%, with over 50% recurring in the liver itself. Combination hepatic arterial infusion (HAI) and systemic chemotherapy in the adjuvant setting post liver resection has been shown to increase both hepatic disease-free survival and overall disease-free survival in several randomized trials. A recent update of the adjuvant trials after liver resection at the Memorial Sloan Kettering Cancer Center has shown a 5-year survival of 78%.

Unfortunately, approximately 85% of patients with colorectal liver metastases will harbor unresectable disease, and this provides a niche area for use of HAI chemotherapy. There is evidence of increased response rates with HAI in this patient group, even after progression on first- and second-line chemotherapy regimens. HAI coupled with systemic chemotherapy also offers the possibility of conversion to resection in a patient population with an inherently poor prognosis and provides a chance for cure.

HAI with systemic chemotherapy is a reasonable and effective treatment option in select patients with oligometastatic disease to the liver in order to achieve improved outcomes. This book chapter reviews the role of HAI chemotherapy in patients with liver metastatic colorectal cancer.

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Author information

Authors and Affiliations

  1. AMV Medical Associates, São Paulo, Brazil

    Vitor Moutinho

  2. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Louise C. Connell & Nancy Kemeny

Authors
  1. Vitor Moutinho
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  2. Louise C. Connell
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  3. Nancy Kemeny
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Corresponding author

Correspondence to Nancy Kemeny .

Editor information

Editors and Affiliations

  1. National Cancer Institute, Rio de Janeiro, Brazil

    Mauro Monteiro Correia

  2. Banner MD Anderson Cancer Center, Phoenix, AZ, USA

    Michael A. Choti

  3. Virginia Mason Medical Center, Seattle, WA, USA

    Flavio G. Rocha

  4. Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Ageo Shi, Saitama, Japan

    Go Wakabayashi

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Moutinho, V., Connell, L.C., Kemeny, N. (2020). Adjuvant Hepatic Arterial Infusion Therapy. In: Correia, M., Choti, M., Rocha, F., Wakabayashi, G. (eds) Colorectal Cancer Liver Metastases. Springer, Cham. https://doi.org/10.1007/978-3-030-25486-5_22

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  • DOI: https://doi.org/10.1007/978-3-030-25486-5_22

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  • Online ISBN: 978-3-030-25486-5

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