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Hepatic Artery Infusion for Recurrent or Chemo Resistant Hepatic Malignancy
Harold J Wanebo¹, *Redy S Srinivasa², *Charu Taneja¹, *Giovanni Begossi³, *James Belliveau¹, *Ritesh Rathore^1
1Roger Williams Medical Center, Providence, RI;²Hurley Medical Center, Flint, MI;³Alta Bates Summit Medical Center, Oakland, CA

Objectives: management of chemoresistant hepatic metastases: Previously treated colorectal metastases (CRC) and advanced hepato-cellular cancer (HCC) are highly resistant to chemotherapy (CT). We reviewed outcome in chemo resistant pts. following hepatic artery infusion (HAI) in 21 CRC pts, 10 HCC pts, and 6 pts with miscellaneous metastases (misc.CA). Methods: Patient groups : 21 CRC pts (16M, 5F); 16 with metachronous and 5 synchronous CA;liver extent: 76% had multiple (>5) or extensive bilateral mets ; CEA(ng/m),>100, 8 pts, >50 (3pts),<5(3pts and, NA - 7 pts. Previous CT: FU/LV (11 pts) plus Oxaliplatin (OX) or Irinotecan (IR) 10 pts. Partial liver Resection/Radio Frequency Ablation (RFA) - 9 pts. HCC 9 pts, cholangio CA 1 pt, M/F 5/5; Previous RX lobectomy 4 pts, RFA/TACE 3 pts. Rx of misc. Gp.(6pts.: HAI was done in metast. lung (1), Breast (2),carcinoid 1pt, adv. gallbladder (GCA) (T3-4) (2 pts) . RxProtocols: CRC : HAI-FUDR 12-15mg/kg/d,(14d) (dexamethasone/ Leukovorin) plus bolus (d1), Oxaliplatin (OX)(or Cisplatin (CIS); Systemic RX: d20-30. OX I.V.130mg/m2 d1, capecitabine750 mg/m2 x 10 days . HCC-Rx : HAI-(d 1-14) as in CRC, with bolus (d1) doxorubicin 75mg/m2, or OX/ CIS as in CRC pts.Results: OS- post HAI in CRC med-17 mos, (2yr/5yr= 27%/6%); HCC median OS = 9 mos (3-12) mos in 9 pts. 1 recurrent HCC pt post lobectomy survived 3.5 yrs with HAI + RFA/TACE (OS 67 mos). Miscell.gp: OS included lung (11 mos), Br Ca (23, 9 mos) adv. carcinoid (3 mos), GBCA (2 pts > 60 mos) . Conclusions: HAI alternating with systemic chemoRx has apparent survival benefit in pts with chemo resistant/metastatic cancers including CRC, HCC, or selected miscell.cancers and warrants further study.

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