TY - JOUR
T1 - Hepatic arterial infusion and systemic chemotherapy after multiple metastasectomy in patients with colorectal carcinoma metastatic to the liver
T2 - A North Central Cancer Treatment Group (NCCTG) phase II study, 92-46-52
AU - Bolton, John S.
AU - O'Connell, Michael J.
AU - Mahoney, Michelle R.
AU - Farr, Gist H.
AU - Fitch, Tom R.
AU - Maples, William J.
AU - Nagorney, David M.
AU - Rubin, Joseph
AU - Fuloria, Jyotsna
AU - Steen, Preston D.
AU - Alberts, Steven R.
N1 - Funding Information:
This study was conducted as a trial of the North Central Cancer Treatment Group and Mayo Clinic and was supported in part by Public Health Service grants CA-25224 , CA-37404 , CA-15083 , CA-63826 , CA-35101 , CA-35195 , CA-35448 , CA-35415 , CA-60276 , CA-63848 , CA-52352 , CA-37417 , CA-35103 , and CA-63849 from the National Cancer Institute Department of Health and Human Services . The content is solely the responsibility of the authors and does not necessarily represent the views of the National Cancer Institute or the National Institutes of Health.
PY - 2012
Y1 - 2012
N2 - Patients undergoing resection of liver metastases from colorectal cancer are at increased risk of liver recurrence. Liver directed therapy has been used to attempt to reduce the risk of liver recurrence. In this trial hepatic artery infusion of FUDR and systemic 5-flouoruracil provided benefit, but do not appear to be better than what can be obtained with modern multidrug chemotherapy. Background: Patients with multiple liver metastases from colorectal cancer are at high risk of recurrence after resection. Hepatic artery infusion (HAI) alternating with systemic therapy after surgical resection may improve survival after surgery. Methods: Patients with liver-only metastases from colorectal cancer amenable to resection/cryoablation were eligible. Previous adjuvant chemotherapy for a completely resected primary tumor was allowed. Alternating courses of HAI and systemic therapy included floxuridine (FUDR) by HAI. Systemic chemotherapy consisted of bolus leucovorin (LV) plus 5-fluorouracil (5-FU). Results: Forty-nine patients had complete resection of their liver metastases, with 44% having more than 4 hepatic metastases and 78% having bilobar disease. Thirty-six patients had HAI FUDR alternating with systemic therapy. Patients received a median of 3.5 cycles (range, 1-4) and 3 cycles (range, 0-6) of therapy with HAI FUDR and systemic therapy, respectively. At the time of final analysis the estimated median disease-free survival and hepatic disease-free survival was 1.2 years (95% confidence interval [CI], 0.9-2.1) and 1.8 years (95% CI, 1.8-not available), respectively. Eleven patients (31%) were alive at this writing. All surviving patients had a minimum of 5.5 years of follow-up. Conclusion: This trial of adjuvant chemotherapy in patients who underwent complete resection with unfavorable characteristics demonstrates apparent improvement in outcome compared with historical series treated with surgery alone. However the results of this trial and other randomized trials of HAI do not appear to support its use at this time because of the development of more effective systemic options.
AB - Patients undergoing resection of liver metastases from colorectal cancer are at increased risk of liver recurrence. Liver directed therapy has been used to attempt to reduce the risk of liver recurrence. In this trial hepatic artery infusion of FUDR and systemic 5-flouoruracil provided benefit, but do not appear to be better than what can be obtained with modern multidrug chemotherapy. Background: Patients with multiple liver metastases from colorectal cancer are at high risk of recurrence after resection. Hepatic artery infusion (HAI) alternating with systemic therapy after surgical resection may improve survival after surgery. Methods: Patients with liver-only metastases from colorectal cancer amenable to resection/cryoablation were eligible. Previous adjuvant chemotherapy for a completely resected primary tumor was allowed. Alternating courses of HAI and systemic therapy included floxuridine (FUDR) by HAI. Systemic chemotherapy consisted of bolus leucovorin (LV) plus 5-fluorouracil (5-FU). Results: Forty-nine patients had complete resection of their liver metastases, with 44% having more than 4 hepatic metastases and 78% having bilobar disease. Thirty-six patients had HAI FUDR alternating with systemic therapy. Patients received a median of 3.5 cycles (range, 1-4) and 3 cycles (range, 0-6) of therapy with HAI FUDR and systemic therapy, respectively. At the time of final analysis the estimated median disease-free survival and hepatic disease-free survival was 1.2 years (95% confidence interval [CI], 0.9-2.1) and 1.8 years (95% CI, 1.8-not available), respectively. Eleven patients (31%) were alive at this writing. All surviving patients had a minimum of 5.5 years of follow-up. Conclusion: This trial of adjuvant chemotherapy in patients who underwent complete resection with unfavorable characteristics demonstrates apparent improvement in outcome compared with historical series treated with surgery alone. However the results of this trial and other randomized trials of HAI do not appear to support its use at this time because of the development of more effective systemic options.
KW - Hepatic arterial infusion
KW - NCCTG
KW - Resected liver metastases
KW - Systemic chemotherapy
UR - http://www.scopus.com/inward/record.url?scp=84861566481&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84861566481&partnerID=8YFLogxK
U2 - 10.1016/j.clcc.2011.03.029
DO - 10.1016/j.clcc.2011.03.029
M3 - Article
C2 - 21729678
AN - SCOPUS:84861566481
SN - 1533-0028
VL - 11
SP - 31
EP - 37
JO - Clinical colorectal cancer
JF - Clinical colorectal cancer
IS - 1
ER -