IN-VITRO DETECTION OF OCCULT BONE-MARROW METASTASES IN PATIENTS WITH COLORECTAL-CANCER HEPATIC METASTASES

PURPOSE: The purpose of this study was to assess the immunocytochemica l status of bone marrow aspirates from patients with clinically isolat ed hepatic metastases to test the hypothesis that such findings would allow improved patient selection for liver-directed treatment. METHODS : All patients had biopsy-proven or presumed colorectal cancer metasta tic to the liver and were scheduled for an operative procedure for hep atic resection or for hepatic artery catheter and chemotherapy pump im plant. Immunocytochemical analysis of bone marrow aspirate smears was performed with a panel of monoclonal antibodies directed toward cytoke ratins, Lewis Y antigen and A-33 colorectal epitopes. RESULTS: Data fr om 80 patients indicated that bone marrow reactivity was present in 9. 5 percent of those with resectable hepatic metastases and in 34 percen t of those not resected (P = 0.03). No single monoclonal antibody or c ombination produced better discrimination. CONCLUSIONS: Presence or ab sence of presumed occult colorectal cancer cells in the bone marrow of patients with isolated hepatic metastases is biologically interesting , but not useful in selecting or altering patient management.