Prolonged and continuous percutaneous intra-arterial hepatic infusion chemotherapy in advanced metastatic liver adenocarcinoma from colorectal primary

Abstract

Sixty patients with advanced metastatic adenocarcinoma of the liver from a colorectal primary were treated by prolonged and continuous intra-arterial hepatic arterial infusion chemotherapy over a period of time from December 1969 through July 1976. A 10-day course of 5-FU was administered in the hospital, and patients were discharged receiving 5-FUDR by continuous arterial infusion through a chronometric infusion pump. Objective responses of 100% were obtained in 15% of patients, 50% response in 39% of patients, and 25% response in 21% of patients. The median survival from onset of treatment was 8.5 months, 6.9 months, and 7 months, respectively, for 100%, 50%, and 25% responders versus 3.6 months for nonresponders. Survivals from onset of treatment were generally less in those with no disease-free interval. No relationship of response to sex and age was found. Patients previously treated with 5-FU intravenously responded to intra-arterial chemotherapy; 13% had a 100% response, and 54% had a 50% response. No relationship of drug dose to response was observed. Drug toxicity was frequently systemic and mild to moderate. Numerous complications occurred due to the catheter, complete or partial thrombosis occurring in 18.6% and 20.8%, respectively, and 30% of patients had displacement of the catheter. The role of partial arterial occlusion in terms of response and survival may be significant. Future studies should involve comparison of direct surgical placement versus percutaneous placement of catheters.

Technical developments: use of targeting guide wire in left subclavian puncture during percutaneous implantation of port-catheter systems using the catheter tip fixation method

“…Among various methods to implant port-catheter systems using interventional techniques [1,2,3,4,5,6,7,8,9,10,11], the procedure of Arai et al [5] (which we employ) is advantageous for long-term infusion chemotherapy. With this procedure, the frequency of hepatic arterial occlusion and catheter dislocation is low [8,9], occurring in only 5.3% [9] and 4.4% [8] of patients, respectively.…”

“…Regarding the access route for an indwelling portcatheter system using interventional techniques, the left subclavian [5,6,7,8,9], hypogastric [5], femoral [1,2], and brachial [3,4] arteries have been used. The use of the former two is advantageous compared with other routes because of the absence of a wide range of motion in the region the catheter passes through that may cause catheter dislocation [5].…”

“…Implanted port-catheter systems for hepatic arterial infusion chemotherapy using interventional techniques have employed various access routes such as transfemoral [1,2], brachial [3,4], hypogastric [5], and subclavian [5,6,7,8] arteries. In this study we percutaneously implanted port-catheter systems via the left subclavian artery with a direct puncture technique aided by a targeting guide wire placed beforehand in the left subclavian artery.…”

Hepatic artery infusion with 5‐fluorouracil and mitomycin‐c in metastatic colorectal carcinoma phase ii study

“…In a neoplasm where liver involvement is frequent and affects survival, the use of hepatic artery infusion (HAI) has a sound rationale [ 10-141. In the last two decades a number of investigators have reported results of treatment of metastatic colorectal carcinoma employing either prolonged continuous ( 2 21 days) [15][16][17][18][19][20] or short-term ( < 2 1 days) [21-241 infusion with 5-FU or FUDR alone or in combination [25,26] with other chemotherapeutic agents. Response rates have been variable but range from 34% to 73 %, with an average about 50%.…”

Assessment of perfusion patterns during hepatic artery infusion chemotherapy: EOE-13 CT and 99mTc-MAA scintigraphy

“…The arterial catheter may be placed percutaneously by a radiologist [1 ] or surgically implanted as part of an infusion pump [2]. Compared with systemic therapy, hepatic artery infusion therapy delivers higher drug concentrations to the liver [3].…”