Chimiothérapie intra-artérielle adjuvante après résection curative de métastases hépatiques d'un cancer colorectal. Résultats d'une étude pilote chez 30 patients*

Intra-arterial chemotherapy after curative resection of colorectal liver metastases. Results of a pilot study in thirty patients.

Objective: Five-year survival after simple resection of liver metastases from colorectal carcinoma ranges from 20 to 40%. The aim was to study the reliability and long term results of adjuvant intra-arterial chemotherapy after resection of colorectal liver metastases.

Patients and method: From 1991 to 1997, 30 patients after a complete resection of liver metastases from colorectal cancer were included (16 men, 14 women, mean age: 62 years). There were 2 stage I, 19 stages II, 2 stages III, 5 stages IV and 2 stages V according to Gayowski staging system. During laparotomy, a catheter was placed in the gastroduodenal artery in order to perfuse the proper hepatic artery. Chemotherapy included 5 Fluorouracil (12 mg/m²) and Leucovorin (200 mg/m²) and was administered once a week during six months. Mean follow-up was 52 months.

Results: Adjuvant intra-arterial chemotherapy had to be interrupted before six months in 9 patients because leukopenia (n=2), infection or obstruction of the catheter (n=5), duodenal migration of the catheter (n=1) and occurrence of multiple extrahepatic metastases (n=1). No death was in relation with the method. Five-year survival rate was 41,8% for the global series. Five-year disease free survival rate was 21,4 %. Causes of death were: hepatic recurrence only (n=3), extrahepatic + hepatic recurrence (n=4), extrahepatic recurrence (n=2). Two patients died of another carcinoma (esophagus, ovary), without evidence of recurrence of the colorectal carcinoma. At the present, there is a recurrence in 4 living patients.

Conclusion: Although the benefit on survival is not significant, these results suggest a longest time of remission in patients with adjuvant intra-arterial chemotherapy. Trials comparing and / or combining this method to intravenous chemotherapy should be proposed in patients after resection of colorectal liver metastases.