Selective chemoembolization in the management of hepatic metastases in refractory colorectal carcinoma: a phase II trial.
OBJECTIVE
Metastatic involvement of the liver frequently determines the evolution of the clinical picture in colorectal cancer patients. We examined the efficacy and toxicity of chemoembolization in this setting, identifying prognostic factors to define patients most likely to benefit from the procedure.


METHODS
Forty patients underwent chemoembolization of metastatic liver lesions from colorectal carcinoma. Selective angiography of the hepatic artery was performed to identify the feeding vessels of the metastatic lesions. The injected chemoemulsion consisted of 1,000 mg of 5-fluorouracil, 10 mg of mitomycin C, and 10 ml of ethiodized oil in a total volume of 30 ml. Gelfoam embolization then followed, until stagnation of blood flow was achieved. Patients were evaluated for response, overall survival, and toxicities.


RESULTS
Overall median survival from date of first chemoembolization was ten months. Factors that predicted a longer median survival included favorable performance status (24 months), serum alkaline phosphatase and lactate dehydrogenase levels less than three times normal (24 and 12 months, respectively), and metastatic disease confined to the liver (14 months). Most patients tolerated the procedure well. The most common side effects were transient fevers, abdominal pain, and fatigue. Three patients died within one month from the procedure.


CONCLUSIONS
This study suggests that chemoembolization of hepatic metastases in colorectal cancer should be further evaluated; it may be beneficial in patients who have failed systemic chemotherapy, have a good performance status, and have metastatic disease confined to the liver.
Sanz-Altamira
P M
PM
Division of Hematology/Oncology, Boston Center for Liver Cancer, Beth Israel Deaconess Medical Center, Harvard Medical School, Massachusetts, USA.
Spence
L D
LD
Huberman
M S
MS
Posner
M R
MR
Steele
G
G
Perry
L J
LJ
Stuart
K E
KE
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000792:Angiography; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D003110:Colonic Neoplasms / Q000473:pathology*; D004998:Ethiodized Oil / Q000008:administration & dosage; D005221:Fatigue / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage; D006490:Hemostatics / Q000008:administration & dosage; D006499:Hepatic Artery; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology*; D015996:Survival Rate
D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D006490:Hemostatics; D016685:Mitomycin; D004998:Ethiodized Oil; D007770:L-Lactate Dehydrogenase; D000469:Alkaline Phosphatase; D005472:Fluorouracil