Combined regional and systemic chemotherapy by a mini-invasive approach for the treatment of colorectal liver metastases

From February 1996 to December 1998, 95 patients affected with colorectal l iver metastases underwent the positioning of an intraarterial hepatic cathe ter by a transcutaneous subclavian access, under local anesthesia. All pati ents were evaluated for catheter implantation complications. Moreover, 61 p atients of 95 treated at our center were retrospectively evaluated for resu lts of chemotherapy performed with two different schedules of hepatic arter y infusion (HAI) combined with systemic chemotherapy (SC). Eleven patients (group A) were treated with combined SC (5-fluorouracil continuous infusion ) and HAI (floxuridine). A subsequent 50 patients underwent HAI (floxuridin e, 4 cycles) followed, if a response or stable disease were observed, by co mbined SC and HAI (group B). Three cases of aneurysm of subclavian artery o ccurred, which were treated by the positioning of a radiologic arterial ste nt and the reimplantation of the catheter by a femoral access. Thrombosis o f the hepatic artery was registered in four cases. We observed 10.5% occurr ence of dislocation of the catheter, which was always moved again in the he patic artery. In group A, with 45% clinical objective response rate and 10% stable disease rate, median survival time and median time to extrahepatic progression were 9 and 6 months, respectively. In group B, we observed 44% clinical objective responses and 26% stable disease after HAI. Patients wit hout disease progression and therefore submitted to sequential SC and HAI h ad a median survival time of 21 months and a median time to extrahepatic pr ogression of 16 months. The development of the mini-invasive technique of i mplantation of an arterial port can avoid laparotomy for HAI. Percutaneous implantation of an arterial port has a low rate of technical complications. HAI followed by combined systemic and regional chemotherapy has good resul ts in terms of survival and time to extrahepatic progression.