Intraarterial chemotherapy in the treatment of liver metastases secondary to colorectal carcinoma

To asses survival and the radiologic response of colorectal liver metastases treated by intraarterial chemotherapy. We used intraarterial chemotherapy to treat 75 patients cytologically diagnosed as having non resectable liver metastases derived from colorectal carcinoma. Computed tomography (CT) of abdomen and pelvis was performed to rule out the presence of disease at other sites. Treatment consisted of continuous perfusion of 5-fluorouracil at a dose of 100 mg/day for 5 days, followed by chemo embolization with an emulsion of lipiodol and 5-fluorouracil (600 mg). The cycles were repeated every 4 weeks and the response was assessed by CT performed prior to administration of the third cycle and 30 days after the sixth. The toxicity was acceptable. One month after the second cycle, 10 patients presented disease progression, 4 showed substantial clinical deterioration and 3 had developed arterial dissection; the treatment was discontinued in all these patients. Fifty-eight patients completed the 6 cycles. In one, the lesions disappeared completely, 51 showed and evident reduction in their size and there were no changes in the remaining 6. the survival rate at one year was 71%, falling to 27% at two years, with a medium survival of 17 months. Survival was greater in those patients whose stage had been Dukes'B prior to treatment (p<0.01) and in those who had shown a radiologic response to treatment (p<0.05). Hepatic intraarterial chemotherapy is associated with low toxicity and a high rate of response, making it the indicated approach in selected patients. The mode of administration should be improved. (Author) 26 refs