A PILOT-STUDY OF MULTIMODALITY THERAPY FOR INITIALLY UNRESECTABLE LIVER METASTASES FROM COLORECTAL-CARCINOMA - HEPATIC RESECTION AFTER HEPATIC ARTERIAL INFUSION CHEMOTHERAPY AND PORTAL EMBOLIZATION

The prognosis of patients with unresectable liver metastases is poor, even if hepatic arterial infusion chemotherapy (HAI) or systemic chemo therapy is administered. A pilot study was performed to evaluate the f easibility and efficacy of multimodality therapy with hepatectomy afte r HAI and portal embolization for such patients, Eight patients with c olorectal carcinoma and synchronous unresectable liver metastases unde rwent resection of the primary tumor and placement of a pump, followed by HAI with 5-fluorouracil and mitomycin C. Owing to shrinkage of the liver metastases, two patients could undergo extended right hepatic l obectomy after portal embolization, which was deemed to be essential t o prevent post-operative hepatic failure. The median survival time of the eight patients was 30 months, with a response rate of 75%, Complic ations including sclerosing cholangitis and duodenal ulcer were observ ed in five patients (63%), Additional hepatectomy could be performed s uccessfully after portal embolization without morbidity in two patient s, These two patients are still alive more than 6 years after initiati on of HAI and have been free of disease for more than 5 years after he patectomy. Hepatectomy after HAI and portal embolization is feasible a nd may be an option to cure selected patients with initially unresecta ble liver metastases.