Hepatic arterial 5-fluorouracil in patients with liver metastases of colorectal cancer: Single-centre experience in 145 patients

Background: Hepatic arterial chemotherapy for liver metastases of colorecta l cancer is still under discussion. Mainly because of the technical complic ations of this mode of treatment and the lack of a survival benefit in rand omized studies. We performed an analysis of hepatic arterial 5-fluorouracil (5-FU) chemotherapy in 145 consecutive patients treated at a single instit ution. Patients and methods: One hundred forty-five patients with inoperable liver metastases from colorectal cancer were included. 5-FU, 1000 mg/m(2)/day co ntinuous infusion for five days every three weeks, was delivered in the hep atic artery by percutaneous catheter or arterial access device. Results: The response rate was 34% for all patients, 40% in patients with e xtrahepatic disease, and 15% in patients with i.v. 5-FU-based pretreatment. TTP and OS for all patients were 7.5 and 14.3 months, respectively. In pat ients with extrahepatic disease or i.v. 5-FU-based pretreatment, OS was sig nificantly shorter compared to patients without extrahepatic disease or 5-F U-based pretreatment (9.7 vs. 19.3 months and 10.1 vs. 17.4 months, respect ively). forty-seven percent of patients stopped treatment because of a comp lication. Complications most often seen in patients with arterial ports wer e hepatic artery thrombosis (48%) and dislocation of the catheter (22%). Conclusions: The results of our analysis are in line with previous phase II I studies. Extrahepatic disease and i.v. 5-FU-based pretreatment were progn ostic for reduced OS. The complication rate of hepatic arterial delivery wa s worrisome, although, no negative impact on survival could be established. There is a strong need for improvement of hepatic arterial delivery method s before further evaluation of hepatic arterial 5-FU will be worthwhile.