Treating unresectable liver metastasis

This study investigated the combination of hepatic artery infusion (HAI) and systemic chemotherapy for the treatment of unresectable colorectal cancer liver metastasis (CRLM).

The liver is the most common site of metastasis (cancer spread) in colorectal cancer patients. Surgical treatments that remove all liver tumors (a complete resection), or kill all tumors with radio pulses (a complete ablation), while leaving the patient with a functional organ represent a potential cure. However, only a small number of patients undergo surgical treatment due to the high number of tumors usually found and their size (referred to as unresectable CRLM). Therefore, conversion therapies, which may shrink CRLM to the point where surgery may be performed are currently under investigation.

Regional hepatic artery infusion (HAI) is a method of delivering drugs such as chemotherapy directly to the region of the cancer cells. This treatment involves placement of a catheter directly into the hepatic artery (the main artery leading blood to the liver). The combination of standard systemic chemotherapy (when chemotherapeutic drugs are administered intravenously and distributed throughout the entire body), and HAI, may provide additional benefit in achieving conversion of unresectable status, and allow for complete resection or ablation. 

This study included 373 patients diagnosed with unresectable CRLM and treated with systematic chemotherapy and HAI at a single medical center from 2000 to 2009.

Of the 373 patients, 25 % (92 patients) had achieved conversion, and had undergone a complete resection or ablation.

While cancer recurrence was noted in 67% of patients after complete resection or ablation (within an average of 16 months), most of these patients were able to undergo additional surgeries. Overall survival was significantly improved in the conversion group (59 months) compared with patients who did not achieve conversion (16 months). Predicted 5 year survival was 6 % for patients who remained unresectable, compared to 47 % for patients in the conversion group.

This study concluded that the combination of HAI and systematic chemotherapy is effective at achieving conversion for patients with extensive CRLM.

This article reported data from a single institution, in a retrospective manner. A multicenter, controlled, trial would provide more objective data regarding this therapeutic approach.

Consult with your physician regarding the benefits and risks of HAI in the treatment of extensive CRLM.