Mi. Doria et al., GASTRIC-MUCOSAL INJURY AFTER HEPATIC ARTERIAL INFUSION CHEMOTHERAPY WITH FLOXURIDINE - A CLINICAL AND PATHOLOGICAL-STUDY, Cancer, 73(8), 1994, pp. 2042-2047
Background. Hepatic arterial infusion chemotherapy (HAIC) of liver met
astases of colon cancer with an implantable pump is associated with li
ver and gastrointestinal complications. Methods. The authors retrospec
tively studied the clinical features and gastric histopathology of nin
e patients who received HAIC and had gastritis develop and in whom bio
psy specimens were available. Results. Gastritis was heralded in these
patients by epigastric pain and tenderness, nausea, vomiting, weaknes
s, and anorexia. In seven patients, 18 gastric ulcers were endoscopica
lly detected. Mucosal damage developed despite prophylactic antiulcer
therapy and healed only upon cessation of HAIC. These observations sug
gest that the predominant drug given, floxuridine, was the responsible
toxic agent. Seventeen biopsy specimens were reviewed, and all exhibi
ted varied histologic evidence of inflammation, reactive glandular cha
nges, and cell necrosis. These mucosal changes were present even in ti
ssues obtained from patients without ulcers. In addition, floxuridine-
induced glandular atypia was noted in eight biopsy samples from six pa
tients. The crowded glands were distorted and lined by large cells tha
t included bizarre forms with pleomorphic nuclei. Conclusions. Gastric
injury in HAIC appeared analogous to the general features encountered
in reactive gastritis resulting from chemical irritants. The glandula
r atypia is peculiar to HAIC, and although the changes were morphologi
cally alarming, in this clinical situation care should be exercised no
t to interpret floxuridine-induced atypia as carcinoma.