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Introduction:Hepatic Artery Infusion(HAI) therapy provides valuable retrieval therapy in patients with liver metastases of colorectal or primary hepatic origin with disease progression in face of multidrug therapy.We are presenting survival outcome data of patients with chemoresistant hepatic metastases.
Methods: We reviewed overall survival(OS) outcome after HAI in chemo resistant patients(pts) including 21 colorectal cancer(CRC)pts, 10 hepatocellular cancer(HCC)pts, and 6pts with miscellaneous hepatic metastases(gall bladder 2pts, breast 2pts, carcinoid and lung 1pt).Patients restaged by clinical LFT, tumor markers, CT, MRI and angiography had operative placement of HAI catheter with infusion pump.Selected resections were done(if reasonable)to augment outcome.Treatment protocol included HAI(FUDR leukovorin,dexamethasone day 1-14, and bolus oxaliplatin/irinotecan day 1)followed by systemic therapy on days 21-30 of bolus oxaliplatin/irinotecan day 21 and daily capecitabine days 21-30.
Results: The treatment group pts included 22pts with colorectal hepatic metastases(CRC):half had progressed on FOLFOX/FOLFIRI and half had progressed after resection +/- RFA.The median survival was 18mos.Among 10 HCC(1cholangio ca)pts 4 were failures of resection and 3pts had previous TACE/RFA therapy.The median survival post HAI was 9mos.1pt with recurrence 2yr after hepatic resection of HCC survived 3.5yr post HAI with supplemental RFA/TACE.In the miscellaneous group(6pts):2 locally advanced GBCA pts were surviving>5yrs post resection with long term HAI; of 2BRCApts OS was 20 and 24mos and OS was 9mos and 4mos in the lung ca and carcinoid pts.HAI was well tolerated and complications included pump malfunction(4pts) misperfusion(2pts), duodenal fistula OT orinfected pocket (2pts)and no mortality.
Conclusion: Hepatic artery infusion alternating with systemic chemo therapy has apparent survival benefit in selected patients with persistent or progressive chemo resistant hepatic malignancy from metastatic CRC, HCC, or selected miscellaneous cancers(abdominal)and warrants further study.