Reuters Health Information (2011-11-21): If colorectal CA reaches liver, chemo via hepatic artery improves survival
If colorectal CA reaches liver, chemo via hepatic artery improves survival
Last Updated: 2011-11-21 18:00:19 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Chemotherapy infused through the hepatic artery can prolong survival once colorectal cancer has spread to the liver, according to a report online October 4th in Annals of Surgery.
Senior author Dr. Michael I. D'Angelica from New York's Memorial Sloan-Kettering Cancer Center told Reuters Health, "This retrospective study is merely hypothesis-generating."
But, he added, it "provides a strong rationale and set of background data to build a randomized prospective trial testing the role of adjuvant hepatic arterial infusion chemotherapy" in patients with colorectal metastases in the liver.
The research team compared 150 patients with resectable liver-confined colorectal metastases (CRLM) who either did or did not receive hepatic artery infusions (HAI) of floxuridine (FUDR) after hepatectomy (125 patients in each group).
Postoperative complication rates were similar in the two groups, and there were no operative deaths.
But after median follow-up of 47 months in the HAI group and 43 months in the control group, three- and five-year disease-specific survival rates were significantly better with HAI (86% and 75%, respectively) than without it (76% and 55%, respectively)(P<0.01).
Estimated overall recurrence-free survival at five years was 48% in the HAI group, compared with 25% in the control group (P<0.01).
Only the use of adjuvant HAI chemotherapy and the presence of solitary liver metastasis independently predicted disease-specific survival. The use of HAI also independently predicted significantly improved overall and hepatic recurrence-free survival.
"In our hospital we frequently treat patients with adjuvant hepatic arterial infusional chemotherapy combined with systemic chemotherapy as adjuvant therapy after resection," Dr. D'Angelica said. "Most frequently patients treated with this combination are enrolled on various prospective trials run at our institution."
"It is hard for us to recommend this therapy to everyone since most hospitals do not offer it," Dr. D'Angelica concluded. "The standard of care in most hospitals is adjuvant systemic chemotherapy alone. We do, however, feel that are results are compelling and accomplish very promising results."
Ann Surg 2011.