MANAGEMENT OF SYMPTOMATIC LOCOREGIONAL RECURRENCE DURING REGIONAL CHEMOTHERAPY FOR COLORECTAL LIVER METASTASES

Background The incidence of symptomatic locoregional recurrence is dou bled in patients receiving regional chemotherapy with hepatic arterial floxuridine infusion (HAI) compared with that in those with colorecta l liver metastases treated by symptom control. This study assessed the management of symptomatic locoregional recurrence in HAI-treated pati ents with colorectal liver metastases. Methods A retrospective review of all patients with colorectal liver metastases treated by HAI in one hospital over a 10-year period was carried out and the management of those who developed symptomatic locoregional recurrence was studied. R esults Twenty-three (14 per cent) of 166 HAI-treated patients with col orectal liver metastases developed symptoms of locoregional recurrence . Liver metastases were responding to HAI at the onset of symptoms in 19 (ten abdominal, nine pelvic recurrence) of the 23 patients. Resecti on of abdominal recurrence was possible in seven of the ten patients, with a median hospital stay of 14 days; there was one perioperative de ath. Resected patients survived a median of 15 months after resection of the recurrence, with five of seven remaining free of symptoms of lo coregional recurrence. In contrast, six of nine HAI-responding patient s with pelvic recurrence treated by external beam radiotherapy died fr om uncontrolled symptomatic pelvic disease. Conclusion Resection of ab dominal recurrence achieved worthwhile palliation in patients with HAI -controlled liver metastases, but palliation of pelvic recurrence by i rradiation was unsatisfactory.