Treatment Options in Colorectal Liver Metastases: Hepatic Arterial Infusion

Abstract

Background: The liver is the most common site for metastases from colorectal cancer (CRC) with the majority of these patients having unresectable disease. Methods: This is a retrospective review of studies using hepatic arterial infusion (HAI) therapy to treat liver metastasis from CRC. A PubMed search of randomized controlled trials and retrospective studies from 2006 to present was conducted using the search terms ‘hepatic arterial infusion (HAI) therapy', ‘colorectal cancer', and ‘treatment of liver metastases'. Results: The first randomized studies comparing HAI to systemic therapy with 5-fluorouracil/leucovorin produced significantly higher response rates of 41 versus 14%. Systemic therapy has improved with the addition of irinotecan and oxaliplatin; however, the responses with HAI and these modern agents have also increased, with responses as high as 80%. For patients with wild-type KRAS, HAI and systemic therapy produced a median survival of 68 months. In patients with refractory disease, response rates are in the 30% range with a median survival of 20 months. Adjuvant HAI after liver resection has shown an increase of hepatic disease-free survival and overall disease-free survival when compared to systemic therapy alone in three of four randomized trials. A recent update of the adjuvant trials after liver resection at Memorial Sloan Kettering Cancer Center has shown a 5-year survival of 78%. Conclusion: HAI therapy has a role in treating hepatic metastases from CRC in both the resectable and unresectable setting.

Survival Outcomes in Unresectable Metastatic Rectal Cancer Patients after both Primary Site Resection and Chemoradiotherapy: A Population-based Study

“…Colorectal cancer liver metastatic disease is a signi cant clinical problem. 15% to 25% of patients with colorectal cancer present with synchronous liver metastases and up to 85% of these patients have unresectable metastatic liver disease [4,6]. Hepatic resection combined with chemotherapy is the standard treatment for metastatic rectal cancer patients and can lead to 5-year OS to 40-50% [9].…”

“…Currently, radical resection is one of the most effective therapies for metastatic colorectal cancer patients. Unfortunately, liver metastases are unresectable in up to 85% of patients initially [6]. The median survival in patients with untreated liver metastasis is reported to be around eight months, and for patients with unresectable liver metastasis, the 5-year overall survival rate is less than 5% [7,8].…”

Minimally Invasive Treatment of a Bronchobiliary Fistula that Developed Secondary to Chemotherapy-induced Stricturing

“…This treatment can be very effective in the treatment of metastatic hepatic tumors; however, it can be associated with potentially serious side effects including damage to the biliary system, referred to as chemotherapy-induced biliary stricturing (CIBS). [3,4] Treatment of BBFs has traditionally aimed to initially decompress the biliary tree through percutaneous or endoscopic drainage, allowing for autonomous occlusion of the fistulous tract. Definitive therapy is with surgical resection, though this is associated with substantial morbidity and mortality.…”

(18-Crown-6)potassium(I) Trichlorido[28-acetyl-3-(tris-(hydroxylmethyl)amino-ethane)betulinic ester-κN]platinum(II): Synthesis and In Vitro Antitumor Activity

“…However, along with killing the cancer cells, such drugs cause severe side effects [5]. While the combined application of few drugs is a common approach in the treatment of cancer, and numerous experimental data both in vitro and in vivo have confirmed the efficacy of such treatment [6][7][8], the conjugation of platinum(II) complexes to biologically (antitumor) active agents is not as profoundly investigated [9][10][11][12]. The first approach, combinational chemotherapy, depends on the biological properties of the single components.…”