Hepatic artery infusion chemotherapy for metastatic colorectal carcinoma

Hepatic metastases are a major cause of morbidity and will affect up to 80, 000 new patients annually in the United States. Up to 20% of these patients will die with metastatic disease localized to the liver. Hepatic arterial infusion (HAI) therapy has a sound anatomical and pharmacological rationale . A number of randomized clinical trials in patients with unresected metast ases have demonstrated that HAI is associated with a complete response rate in 5% of patients and partial responses up to 60%. In comparison, systemic chemotherapy is associated with a partial response in 20% of cases. No inv estigation comparing systemic chemotherapy with HAI has demonstrated an imp rovement in survival following HAI, since all investigations either allowed crossover, were under-powered with respect to survival statistics, or incl uded patients with extrahepatic disease in the HAI arm. However, a recent i nvestigation utilizing HAI with systemic chemotherapy following hepatic res ection demonstrates improved local and systemic disease control and overall survival. This approach offers new promise for the curative treatment of t he patients with metastatic colorectal carcinoma. Semin. Surg. Oncol. 19:12 5-134, 2000. (C) 2000 Wiley-Liss, Inc.