Therapeutic strategy for postoperative liver metastasis from esophageal squamous cell carcinoma; clinical efficacy of and problem with hepatic arterial infusion chemotherapy.
OBJECTIVE
Despite recent advances in diagnosis and treatment, the prognosis for esophageal squamous cell carcinoma is unsatisfactory. Liver recurrence is frequent in postoperative esophageal squamous cell carcinoma patients, and the prognosis for patients with liver metastasis is poor. This report concerns the therapeutic strategy, especially the efficacy of and the problem with hepatic arterial infusion chemotherapy for liver metastasis from esophageal squamous cell carcinoma.


METHODS
We performed a retrospective analysis of 8 patients who underwent hepatic arterial infusion between 1993 and 1998. All patients underwent esophagectomy and reconstruction with stomach roll without preoperative chemotherapy and/or radiotherapy. For 6 patients, preceding systemic chemotherapy was performed before hepatic arterial infusion.


RESULTS
The overall response rate of hepatic arterial infusion was 50%, and for the responders, hepatic arterial infusion provided a good quality of life. Hepatic arterial infusion was effective for responders to preceding systemic chemotherapy, but ineffective for non-responders. A complete response was seen in 2 patients, and the liver tumors showed no re-growth after the completion of hepatic arterial infusion. Two patients developed stomach roll ulcers and one experienced the catheter thrombosis, but there were no instances of severe toxicity or complications.


CONCLUSIONS
For postoperative liver recurrence of esophageal squamous cell carcinoma, hepatic arterial infusion is the favorable therapy in terms of efficacy and low-grade toxicity, but has a risk of causing severe complications. We consider it suitable that when preceding systemic chemotherapy is performed before hepatic arterial infusion, hepatic arterial infusion is performed in responders to preceding systemic chemotherapy, and that hepatic arterial infusion is continued as long as possible.
Nakajima
Y
Y
First Department of Surgery, Tokyo Medical and Dental University School of Medicine, Yushima 1-5-45, Bunkyo-ku, Tokyo 113-8519, Japan. yasu.nakajima.srg1@tmd.ac.jp
Nagai
K
K
Kawano
T
T
Inoue
H
H
Nara
S
S
Kumagai
Y
Y
Iwai
T
T
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome