PHASE-II TRIAL OF CHEMOEMBOLIZATION FOR THE TREATMENT OF METASTATIC COLORECTAL-CARCINOMA TO THE LIVER AND REVIEW OF THE LITERATURE

BACKGROUND. Hepatic artery chemoembolization represents an alternative treatment for patients whose neoplastic lesions are not amenable or h ave become refractory to other treatment modalities. This project was designed to test the feasibility of regional chemoembolization for pat ients with colorectal carcinoma metastasis to the liver who had experi enced failure with one or more systemic treatments. METHODS, Thirty pa tients who met the study entry criteria underwent one to three hepatic artery chemoembolizations. The chemoembolization regimen consisted of an injection of a bovine collagen material with cisplatin (10 mg/mL), doxorubicin (3 mg/mL), and mitomycin C (3 mg/mL). Repeat treatments w ere performed at 6- to 8-week intervals. RESULTS, Radiologic responses , as measured by a decrease in lesion density of at least 75% of the l esion or a 25% decrease in the size of the lesion, occurred in 63% of tile cases. A decrease of at least 25% of the baseline carcinoembryoni c antigen level occurred in 95% of the cases. AU responses were transi ent. Median survival for all 30 patients was 8.6 months after the init iation of chemoembolization and 29 months after the initial diagnosis of metastasis to the liver. Common toxicities included a ''pastemboliz ation syndrome,'' which consisted of fever > 101 similar to F (83%), p ain in the right upper quadrant (100%), nausea, and vomiting. Lethargy was a common occurrence (in 60+% of cases) and lasted up to 6 weeks. Hematologic toxicities included leukocytosis, anemia, and thrombocytop enia. CONCLUSIONS. Chemoembolization is a feasible treatment modality for patients with colorectal carcinoma metastasis to the liver who hav e experienced failure with other systemic treatments. It results in hi gh response rates with transient mild-to-moderate toxicity. Responses are measured in months, however, and all patients have eventual progre ssion of disease. Patients who are able to undergo three or more chemo embolization procedures may receive the most clinical benefit. (C) 199 8 American Cancer Society.