Sarcomas metastatic to the liver: Response and survival after cisplatin, doxorubicin, mitomycin-C, ethiodol, and polyvinyl alcohol chemoembolization

PURPOSE: To evaluate the response to and survival after chemoembolization w ith cisplatin, doxorubicin, mitomycin-C, Ethiodol, and polyvinyl alcohol fo r patients with sarcomas metastatic to the liver that are surgically unrese ctable. MATERIALS AND METHODS: Sixteen patients were treated. Primary tumors includ ed 11 gastrointestinal leiomyosarcomas, two splenic angiosarcomas, one leio myosarcoma of the broad ligament, one leiomyosarcoma of the inferior vena c ava, and one malignant fibrous histiocytoma of the colon. Chemoembolization with cisplatin, doxorubicin, mitomycin-C Ethiodol, and polyvinyl alcohol p articles was performed 1-5 times at approximately monthly intervals (mean, 2.8). Pre- and posttreatment cross-sectional imaging was performed 1 month after completion of treatment and then every 3 months. Thirty-day response was graded according to World Health Organization/Eastern Cooperative Oncol ogy Group criteria. Survival was calculated with use of Kaplan-Meier analys is. RESULTS: Two patients (13%) exhibited partial morphologic response, 11 pati ents (69%) were morphologically stable, and three (19%) demonstrated progre ssion of disease 30 days after completion of treatment. Among the 13 respon ders, two underwent partial hepatectomy after initial treatment. Seven deve loped intrahepatic progression at a mean of 10 months and a median time of 8 months. The remaining four patients had no documented intrahepatic progre ssion at the time of last imaging follow-up. Nine patients developed extrah epatic progression at a mean time of 6.3 months and a median time of 6 mont hs, of whom four underwent additional surgical resection. Response to thera py was based on time of first intervention. Cumulative survival from time o f diagnosis with use of Kaplan-Meier analysis was 81% at 1 year, 54% at 2 y ears, and 40% at 3 years. Median survival time was 20 months. Cumulative su rvival from initial chemoembolization was 67% at 1 year, 50% at 2 years, an d 40% at 3 years, with a median survival time of 13 months. The thirty-day mortality rate was zero. CONCLUSION: Durable tumor response with chemoembolization is possible in th is form of metastatic disease, which is highly resistant to systemic chemot herapy.