CONTINUOUS ARTERIAL 5-FLUOROURACIL AND FOLINIC ACID CHEMOTHERAPY FOR COLORECTAL LIVER METASTASES

Background: A liver resection is only possible for about 20% of all pa tients suffering from liver metastases from colorectal cancer. Alterna tively, intra-arterial chemotherapy is an attractive treatment against non-resectable isolated liver metastases, though this is not a proven method to date. Aim: As an alternative to the FUDR fluorodesoxyuridin e) therapy with its high local toxicity, we assessed a regional therap y with 5-FU (fluorouracil) using the modulation with FA (folinic acid) as a continuous application. Patients and Methods: In 16 patients wit h non-resectable liver metastases an intra-arterial port was implanted to carry out the ambulant chemotherapy. The intra-arterial catheter w as placed after explorative laparotomy across the gastroduodenal arter y with the tip tangential to the hepatic artery. The initial dose tota lled to 1,000 mg/m(2) body surface 5-FU and 200 mg/m(2) FA. 5-FU was a pplied continuously for 5 days simultaneously with FA as a daily short infusion. The therapy was repeated every 28 days. A total of 115 cycl es was evaluated according to WHO grading. Results: The therapy was as sociated with the following non-haematological side-effects (WHO grade 2-3): stomatitis (52%), nausea/vomiting (12%), diarrhea (11%), pain ( 3%), skin reaction (7%), hair loss (3%). The dose has to be reduced af ter the first cycle in 6 patients due to grade 3 toxicity. The respons e rates were: complete remission 2 patients, partial remission 7 patie nts, stable disease 4 patients, progression 3 patients. The median sur vival time of the 16 patients was 24 months. Progression occurred afte r a median time of 16 months.Conclusion: This study shows the effectiv ity of ambulant continuous 5-FU/FA application with controllable syste mic side-effects without local toxicity. The demonstrated high rate of complete plus partial response rate and extended survival rate should be evaluated in a randomized trial with systemic treatment.