Selective Intra-arterial Chemotherapy with Floxuridine as Second- or Third-Line Approach in Patients with Unresectable Colorectal Liver Metastases

• Published in: Annals of surgical oncology 2011-07, Vol.18 (7), p.1924-1931
• Main Authors: Samaras, Panagiotis, Breitenstein, S., Haile, S. R., Stenner-Liewen, F., Heinrich, S., Feilchenfeldt, J., Renner, C., Knuth, A., Pestalozzi, B. C., Clavien, P. A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cohort Studies; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - pathology; Female; Floxuridine - administration & dosage; Fluorouracil - administration & dosage; Follow-Up Studies; Hepatic Artery; Hepatobiliary Tumors; Humans; Infusions, Intra-Arterial; Leucovorin - administration & dosage; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - pathology; Oncology; Organoplatinum Compounds - administration & dosage; Prospective Studies; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Treatment Outcome
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-010-1505-2

Background An outcome assessment was performed of patients with unresectable colorectal liver metastases (CRLM) treated in second or third line with floxuridine (FUDR)-based hepatic artery infusion (HAI). Methods Twenty-three patients who were pretreated with systemic (immuno)chemotherapy received FUDR-HAI alone or combined with systemic chemotherapy. We reviewed patient charts and our prospective patient database for survival and associated risk factors. Results Patients received FUDR-HAI for unresectable CRLM from January 2000 to September 2010. Twelve patients (52%) received concurrent systemic chemotherapy. Median overall survival (OS), progression-free survival (PFS), and hepatic PFS were 15.6 months (range, 2.5–55.7 months), 3.9 months (range, 0.7–55.7 months), and 5.5 months (range, 1.6–55.7 months), respectively. The liver resection rate after HAI was 35%. PFS was better in patients undergoing secondary resection than in patients without resection (hazard ratio [HR] 0.21; 95% confidence interval [95% CI] 0.07–0.66; P  = 0.0034), while OS showed a trend toward improvement (HR 0.4; 95% CI 0.13–1.2; P  = 0.09). No differences were observed in OS ( P  = 0.69) or PFS ( P  = 0.086) in patients who received FUDR-HAI alone compared with patients treated with combined regional and systemic chemotherapy. No statistically significant differences were seen in patients previously treated with one chemotherapy line compared with patients treated with two lines. Presence of extrahepatic disease was a negative risk factor for PFS (liver-only disease: HR 0.03; 95% CI 0.0032–0.28; P