Technical complications of continuous intra-arterial chemotherapy with 5-fluorodeoxyuridine and 5-fluorouracil for colorectal liver metastases.
BACKGROUND
Intra-arterial chemotherapy is an effective modality to treat unresectable hepatic metastases from colorectal primaries if systemic chemotherapy has failed. Response rates of more than 40% and a median survival of 15 to 25 months have been reported from randomized trials. In this retrospective study, we analyzed specific technical complications associated with continuous intra-arterial chemotherapy for colorectal liver metastases.


METHODS
From 1982 to 1995, single-center clinical data from 180 patients with colorectal liver metastases were evaluated. Continuous intra-arterial chemotherapy was administered using either an implanted infusion pump or an intra-arterial port with an external infusion pump. The intra-arterial catheter was implanted according to the Watkins' technique. The treatment protocols consisted of 5-fluorouracil- or 5-fluorodeoxyuridine-based regimens.


RESULTS
A total of 70 patients (39%) received an intra-arterial infusion pump and 110 patients (61%) an intra-arterial port. Sixty-eight technical complications affected port systems (62%), whereas 29 patients with pumps (41%) were affected by technical complications. Therapy-relevant complications were observed in 47% of the ports and 30% of the infusion pumps. The median complication-free survival was 12.2 months for infusion pumps and 7.3 months for ports (P =.0016).


CONCLUSIONS
Our data demonstrate that pumps are superior to ports in terms of complication rate and complication-free survival. On the basis of our results, pumps have a potential for a longer treatment, which may result in a prolonged median survival.
Heinrich
Stefan
S
Department of General and Vascular Surgery, University of Frankfurt Medical Center, Frankfurt, Germany.
Petrowsky
Henrik
H
Schwinnen
Ingo
I
Staib-Sebler
Elsbeth
E
Gog
Christiane
C
El-Ganainy
Ahmed
A
Gutt
Carsten
C
Müller
Hans-Helge
HH
Lorenz
Matthias
M
D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D002404:Catheterization / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage*; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D007260:Infusion Pumps / Q000009:adverse effects; D007261:Infusions, Intra-Arterial / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D011182:Postoperative Care; D012189:Retrospective Studies
D000964:Antimetabolites, Antineoplastic; D005467:Floxuridine; D005472:Fluorouracil