Treatment of Liver Metastases with Hepatic Arterial Infusion Therapie von Lebermetastasen mit arterieller Leberperfusion

Summary: Background: In 2002 colorectal carcinoma (CRC) will affect more than 700,000 patients. Approximately 60 % of patients with colorectal cancer will go on to develop hepatic metastases and in one third, it will be the only site of involvement. The management of 1 – 3 liver metastases from CRC is surgical resection; however, 75 % of patients who undergo hepatic resection will recur within 2 years. Systemic chemotherapy and hepatic arterial infusion therapy (HAI) are used in the adjuvant setting following hepatic resection and in nonresectable patients.Methods: The results of chemotherapy trials from our institution and from the literature in patients with liver metastases of colorectal cancer are reported.Results: Ninety percent of patients will be ineligible for resection and usually receive systemic chemotherapy. Although combination of new agents such as CPT-11 or oxaliplatin with 5-fluorouracil has produced response rates of approximately 40 % and increased median survival to 14 – 15 months, generally less than 25 % of patients are alive at 2 years. In the treatment of nonresectable hepatic metastases from colorectal cancer, several trials demonstrated a significant increase in response rate and progression-free survival with HAI compared to systemic therapy. In a randomized trial of combination therapy of HAI and systemic therapy (HAI + SYS) versus systemic therapy (SYS) alone in patients undergoing resection of hepatic metastases at Memorial Sloan-Kettering Cancer Center, survival was significantly increased with HAI + SYS (86 %) vs. SYS alone (72 %) at 2 years (P = 0.03).Conclusion: Hepatic arterial infusion therapy allows the administration of high doses of chemotherapy locally. Response rates with HAI therapy have been shown in multiple studies to be higher than those attainable with systemic chemotherapy. Additional work is needed to investigate the role of other systemic chemotherapeutic agents with HAI.