ADJUVANT REGIONAL CHEMOTHERAPY AFTER RESECTION OF COLORECTAL LIVER METASTASES

Due to the pattern of tumor infiltration, hepatic resection may be acc omplished in 20 % of all patients with colorectal liver metastases. Ho wever, a new recurrence is observed very often and early. Up to date, systemic adjuvant treatment failed to improve the overall results. Tak ing into account the benefit of palliative intrahepatic chemotherapy, intraarterial therapy was performed as an adjuvant to removal of metas tatic colorectal liver metastases in 51 out of 90 patients over an eig ht year period (1982-90). Due to abnormal arterial liver arteries 5 pa t. got an intraportal catheter. The following monthly treatment schedu les were applied: FUDR (fluorodesoxyuridine) 0.2-0.3 mg/kg/d/14 d (N = 12), FUDR 1,2 mg/kg/d/5d (N = 21), FUDR 1.0-1.7 mg/kg/d/5 d and folin ic acid 30 mg/m2/d (N = 18). Mortality (5,5 %) and morbidity (36 %) we re not increased by catheter implantation. Local and systemic side eff ects were mainly stomatitis 0-22 % and hepatobiliary toxicity 6-42 %. Including an operative mortality of 5,5 %, the median survival of 45 m onths was associated with a disease-free interval of 15 months. Intrah epatic recurrence was diagnosed after a median time of 26 months (extr ahepatic recurrence was 25 months respectively). The following prognos tic factors were associated with favourable survival: solitary metasta sis (p > 0.001), curative resection, segmentectomy, normal serum level s of CA 19-9 and LDH. Although both groups were not comparable, due to more extended tumor infiltration in the treatment group (p = 0.03), a djuvant arterial chemotherapy delayed after curative resection intrahe patic recurrence to 52 versus 14 months (p = 0.036). Disease-free surv ival was improved to 19 versus 12 months (p = 0.08) resulting in a tre nd to better overall survival (p = 0.07).