Limited but definite efficacy of prophylactic hepatic arterial infusion chemotherapy after curative resection of colorectal liver metastases - A randomized study

BACKGROUND. Greater than 50% of patients who undergo curative resection of liver metastases from colorectal carcinoma develop recurrent disease in the residual liver. Although several studies have attempted to use hepatic art erial infusion (HAI) chemotherapy to prevent recurrence, to the authors' kn owledge the efficacy of the treatment has not yet been determined. METHODS. Nineteen patients who underwent curative hepatectomy for metastati c colorectal carcinoma randomly were assigned into the HAI group (nine pati ents) or the control group (ten patients). Patients in the HAI group receiv ed continuous intraarterial infusion of 5-fluorouracil (5-FU) (500 mg/day) for 4 days followed by a 3-day rest. The treatment was continued for 6 week s. RESULTS. The median follow-up period was 62.2 months. The recurrence was co nfirmed in three patients in the HAI group and in eight patients in the con trol group. Of these, recurrence in the remnant liver was observed in one p atient and in six patients, respectively. The median disease free interval after hepatectomy was 62.6 months in the HAI group and 13.8 months in the c ontrol group. The 1-year, 2-year, and 3-year disease free survival rates we re 77.8%, 77.8%, and 66.7%, respectively, in the HAI group and 50.0%, 30.0% , and 20.0%, respectively, in the control group. Significant prolongation o f disease free survival was observed in the HAI group (P = 0.045). No patie nts in the HAI group reported any adverse effect of greater than or equal t o Grade 2 (according to the National Cancer institute Common Toxicity Crite ria). Two patients in the HAI group and five patients in the control group were dead of disease at the time of last follow-up. The 1-year, 3-year, and 5-year cumulative survival rates for the HAI group were 88.9%, 77.8%, and 77.8%, respectively, whereas those of the control group were 100.0%, 50.0%, and 50.0%, respectively (P = 0.2686). CONCLUSIONS. This randomized study revealed that short term HAI of 5-FU aft er curative resection of colorectal hepatic metastases is effective in prev enting the recurrence of disease without any serious complications. (C) 200 0 American Cancer Society.