Regional versus systemic chemotherapy in the treatment of colorectal carcinoma metastatic to the liver. Is there a survival difference? Meta-analysis of the published literature.
BACKGROUND
A number of articles have appeared in the medical literature regarding regional infusion chemotherapy for the treatment of metastatic colorectal carcinoma confined to the liver. The results and conclusions have been varied. A meta-analysis of the literature was undertaken to determine if regional infusion chemotherapy using either 5-fluorouracil or floxuridine (FUDR) confers a survival advantage over systemic chemotherapy for the treatment of this disease.


METHODS
A MEDLINE search was conducted encompassing the period from January 1976 to May 1995. The search was narrowed to include only articles that referenced prospective randomized clinical trials. A total of 149 articles or abstracts were reviewed for potential eligibility in this meta-analysis. Six articles met the current study inclusion criteria. One and 2-year survival rates for each treatment modality were directly retrieved from each study or calculated from the Kaplan-Meier survival curves that were presented. Prior to pooling the estimates of the treatment survival differences, a test was conducted for homogeneity of the treatment effect using the test statistic proposed by DerSimonian and Laird 1986. The fixed effect model was then used to obtain summary estimates of the survival differences from the group of studies.


RESULTS
Regional infusion chemotherapy with FUDR produced a 10% (P = 0.041) and 6% (P = 0.124) increased survival at 1 and 2 years, respectively.


CONCLUSIONS
Based on this meta-analysis, it appears that hepatic artery infusion chemotherapy confers a modest survival benefit over systemic chemotherapy. Whether this is clinically relevant depends on the quality rather than just the duration of survival.
Harmantas
A
A
Harvard University School of Public Health, Boston, Massachusetts, USA.
Rotstein
L E
LE
Langer
B
B
D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005467:Floxuridine / Q000008:administration & dosage*; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary*; D015996:Survival Rate; D016896:Treatment Outcome
D005467:Floxuridine; D005472:Fluorouracil