Intraarterial Chemotherapy for Colorectal Liver Metastases and Hepatomas Using a Totally Implantable Drug Infusion Pump

Abstract

Continuous regional chemotherapy for treating hepatic tumors is a rational pharmacological approach as palliative treatment in selected patients, such as those with hepatocellular carcinoma and metastatic colorectal carcinoma. Continuous regional chemotherapy has the following advantages: (1) it delivers a higher concentration of drug directly to the liver tumor since it avoids a dilutional effect that otherwise occurs with a systemic (intravenous) injection; (2) many antimetabolites have a more effective antineoplastic effect when administered by a chronic infusion rather than by pulse injection; (3) there is significant hepatic extraction of many drugs when injected directly into the hepatic circulation, particularly fluorodeoxyuridine (FUdR) and to a lesser extent 5-fluorouracil (5-FU), mitomycin C, and adriamycin; this further increases the concentration of the drug at the site of the liver neoplasm; and (4) continuous infusion (either intraarterially or intravenously) has a lower peak serum concentration, thus decreasing toxicity such as marrow depression with FUdR and 5-FU, or cardiotoxicity with adriamycin [15, 19, 22, 29]. There are some disadvantages to this approach as well. First, there is less systemic exposure of the drug so that metastases at extrahepatic sites are not treated to the same degree. Second, there can be significant local toxicity, especially chemical hepatitis, cholecystitis, and gastritis.