title: Systemic irinotecan and regional floxuridine after hepatic cytoreduction in 185 patients with unresectable colorectal cancer metastases.
abstract: BACKGROUND
  This study evaluated our 7-year experience treating unresectable colorectal cancer (CRC) hepatic metastases refractory to systemic 5-fluorouracil.
  
  
  METHODS
  A total of 185 patients with unresectable 5-fluorouracil-resistant CRC hepatic metastases underwent surgical cytoreduction. Postoperatively patients received either hepatic arterial floxuridine (FUDR) and systemic irinotecan as part of a phase II trial or no further treatment.
  
  
  RESULTS
  Of the 185 patients undergoing surgical cytoreduction, 71 patients received adjuvant irinotecan/FUDR. There were no appreciable differences in synchronous or metachronous lesions or the median number or size of lesions between treatment groups. At a median follow-up of 20 months, there were fewer recurrences in patients treated with postoperative irinotecan/FUDR compared with untreated patients for both hepatic and extrahepatic recurrences. Progression-free and overall survival were longer for patients who received irinotecan/FUDR compared with patients who did not receive adjuvant therapy. The 2-year survival rate was significantly better for patients receiving adjuvant therapy compared with patients receiving no additional treatment. Predictors of improved survival included a preoperative carcinoembryonic antigen level <100 ng/dl, >30% postoperative reduction in carcinoembryonic antigen level, and adjuvant therapy.
  
  
  CONCLUSIONS
  Combined therapy with irinotecan/FUDR may improve the results of surgical cytoreduction for unresectable CRC hepatic metastases.
authors.affiliation: Division of Surgical Oncology, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, California, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Litvak
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Wood
authors.forename: George J
authors.initials: GJ
authors.lastname: Tsioulias
authors.forename: Mathew
authors.initials: M
authors.lastname: Chung
authors.forename: Sant P
authors.initials: SP
authors.lastname: Chawla
authors.forename: Leland J
authors.initials: LJ
authors.lastname: Foshag
authors.forename: Donald L
authors.initials: DL
authors.lastname: Morton
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Ramming
authors.forename: Anton J
authors.initials: AJ
authors.lastname: Bilchik
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002140:California / Q000453:epidemiology; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D003131:Combined Modality Therapy; D003452:Cryosurgery; D018572:Disease-Free Survival; D005467:Floxuridine / Q000008:administration & dosage; D006801:Humans; D015918:Infusion Pumps, Implantable; D007261:Infusions, Intra-Arterial; D000077146:Irinotecan; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D015996:Survival Rate
chemical_list: D005467:Floxuridine; D000077146:Irinotecan; D002166:Camptothecin