HIGH-DOSE INTRAARTERIAL PLUS INTRAPERITONEAL CHEMOTHERAPY COMBINED WITH HEMOFILTRATION IN LIVER METASTASES FROM COLORECTAL-CANCER

Aims: Twenty-three patients with liver metastases from colorectal canc er were entered into a prospective, phase II pilot study to evaluate t he efficacy and feasibility of intra-arterial high-dose chemoterapy (I AHC) + intraperitoneal chemotherapy (IPC) combined with hemofiltration . Methods: All patients had abdominal laparotomy to position a hepatic artery infusion port and in 15 cases an implantable system for IPC. A double-lumen filtration catheter was placed in the vena cava via the saphenous or femoral vien and connected to a modified hemofiltration u nit. The treatment schedule consisted of mitomycin (30-50 mg/m2) and e pirubicin (60-90) mg/m2) as IAHC combined with cisplatin (60 mg/m2) gi ven in a 2000 ml saline solution by IPC. The high-dose IAHC-IPC was fo llowed by 4 cycles of intra-arterial standard dose chemotherapy throug h the arterial port-a-cath (6 mg/m2 mitomycin and 20 mg/m2 epirubicin) and if possible by another cycle of high dose IAHC-IPC. Results: We d elivered a toal of 31 cycles of IAHC, 21 of which were combined with I PC. Ten cycles of IAHC were administered without concurrent IPC becaus e of painful adhesions, clinical contraindications or patient refusal. Seven of 23 patients (30%) were pretreated and with progressive disea se after systemic chemotherapy. Among 22 evaluable patients, we obtain ed 2 complete remissions (9%) and 11 partial remissions (50%); moreove r, 4 of 7 pretreated patients obtained a response to treatment. As a r esult an objective tumor response was observed in 59% of patients (13/ 22). Therefore, a dose-response behavior was demonstrated also in tumo rs with a low chemosensitivity. The median duration of response and su rvival was 10 and 14 months, respectively. Toxicity was usually mild, but we reported one toxic death due to treatment complications. Conclu sions: Further prospective randomized studies are needed to confirm th e results of our study.