[Complications of intra-arterial infusion chemotherapy in patients with colorectal cancer with liver metastasis, with special reference to IA-5-FU induced sclerosing cholangitis].
Fifty-nine colorectal cancer patients with metastatic liver cancer who underwent intra-arterial infusion chemotherapy (IAIC) at the National Cancer Center Hospital from May 1986 to February 1989 were reviewed. Excisions of metastatic liver cancer were performed in 36 patients and 23 had nonresectable metastatic liver cancer. Catheter troubles, including severe infections (8), extravasations (3), obstruction (1) and other (1) occurred in 13 (22.0%) patients, and 6 patients (10.2%) were unable to receive IAIC. Three patients did not undergo IAIC because of hepatitis or other reasons. Serious complications following IAIC, including sclerosing cholangitis (SC) (6), extravasations (6) and obstructions (3) were observed in 15 patients (30.0%). 5-Flourouracil (5-FU) (700 mg/m2) and mitomycin C (MMC) (7 mg/m2) were infused through implantable pumps weekly or every two weeks. Total infused doses of 5-FU ranged from 7,000 to 26,250 mg (mean: 11,800 + 7,700 mg) and those of MMC from 24 to 84 mg (mean: 45.3 + 25.8 mg) in 6 patients (12%) with SC, 4 resectable and 2 non-resectable cases. All six patients with SC had cholangiographic abnormalities of the biliary tract by endoscopic retrograde cholangiography (ERCP) or percutaneous transhepatic cholangiography (PTC), but serial CT examination of the liver did not show any progression of the tumor at the hilum in these patients. Segmental stricture at the common hepatic duct and bifurcation appeared specific to IA-5-FU induced SC. Obstructive jaundice occurred in 3 patients. Four patients had epigastralgia and 3 exhibited elevated alkaline phosphatase level prior to the cholangiographic examination. The elevated level of alkaline phosphatase was reversible in one patient without obstructive jaundice. Although the relation of the sclerosing process to IA-5-FU dose is not yet clear as well as IA-FUDR, it should be important to make an early detection of SC by ERCP and also to discontinue IAIC as soon as possible. In our opinion, SC may relate to the arterial delivery of 5-FU. In order to prevent SC, devascularization of the right hepatic artery via surgical procedures may well be effective, because retrograde flow from the right hepatic artery was confirmed by several clinical and anatomical studies.
Sawada
T
T
Dept. of Colorectal Surgery, National Cancer Center Hospital.
Hojo
K
K
Moriya
Y
Y
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D002404:Catheterization / Q000009:adverse effects; D015209:Cholangitis, Sclerosing / Q000139:chemically induced*; D002779:Cholestasis / Q000139:chemically induced; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007260:Infusion Pumps / Q000009:adverse effects; D007261:Infusions, Intra-Arterial / Q000009:adverse effects / Q000379:methods; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D016685:Mitomycin; D008937:Mitomycins / Q000008:administration & dosage / Q000009:adverse effects
D008937:Mitomycins; D016685:Mitomycin; D005472:Fluorouracil