A prospective, randomized evaluation of the treatment of colorectal cancer metastatic to the liver.

Abstract

Over a 4-year period (1982 to 1986), 91 patients with solitary or multiple metastases from colorectal cancer were stratified, based on findings at laparotomy, to one of three groups and then prospectively randomized to one of two treatment arms within each group. Group A patients had solitary resectable metastases, group B patients had multiple, resectable metastases, and group C patients had multiple, unresectable metastases. Patients were randomized to one of two treatment arms within a group: group A-arm A1: resection only, arm A2: resection and continuous hepatic artery infusion (CHAI) of fluorodeoxyuridine (FUdR); group B-arm B1: resection and CHAI, arm B2: CHAI only; group C-arm C1: CHAI, arm C2: systemic fluorouracil followed by CHAI. Median time to failure (TTF) was 31.8, 11.1, and 8.8 months for groups A, B, and C, respectively. Arm A2 had an improved TTF when compared with arm A1 (P = .03). Median survival correlated with extent of disease and was 37.3, 22.4, and 13.8 months for groups A, B, and C, respectively. Survival was not changed by treatment variation (arms) within each group. Two- and 5-year cumulative survivals for groups A, B, and C were 72.7% and 45.4%; 45.8% and 16.7%; and 31.7% and 3.2%, respectively. In patients with multiple metastases (groups B and C), those patients whose original tumor was a Dukes' B had a significantly improved TTF and survival over those patients whose tumor was a Dukes' C (P less than or equal to .02).

Surgical treatment of colorectal metastases to the liver

“…It is clear that intrahepatic chemotherapy is an effective therapy and is associated with a significantly higher number of responses than systemic chemotherapy. [42][43][44][45][46][47] The response rates for HAI were 48 to 62 percent, compared with zero to 21 percent for intravenous therapy. Critics have pointed out that this increase in response rate has translated to increased survival in only one study.…”

Interstitial photodynamic therapy in a rat liver metastasis model

“…However, only 5-10% of patients with hepatic metastases from colorectal cancer are amenable to this type of therapy, and the operative mortality and morbidity rates are relatively high (4-25% and 16-46%, respectively) (Steele & Ravikumar, 1989;Sugerbaker & Kemeny, 1989;Wagman et al, 1990). Photodynamic therapy (PDT) is a relatively new local treatment modality, which has been used successfully in the treatment of various malignant tumours, including cancer of the bladder, skin, upper respiratory tract and gastrointestinal tract (Dougherty, 1987;Manyak et al, 1988;Gomer, 1989;Wilson et al, 1991).…”

The role of floxuridine in metastatic liver disease

“…To show a 50% increase in median survival, a study would need 100 patient deaths per study arm to provide a power of 82%. None of the first seven randomized trials up to 1994 were large enough to answer this question (25)(26)(27)(28)(29)(30)(31) (28) studies in which patients with progression of disease in the systemic arms were allowed to crossover to HAI treatment. (3) In some studies, e.g., the Mayo and NCOG studies, some patients had extrahepatic disease and were included, therefore it is difficult to show a survival advantage if no systemic drug is administered (25,27).…”