title: Adjuvant hepatic arterial chemotherapy following metastasectomy in patients with isolated liver metastases.
abstract: OBJECTIVE
  To examine survival and toxicity by querying a single-institutional experience with adjuvant hepatic arterial infusional (HAI) chemotherapy.
  
  
  BACKGROUND
  Three randomized series in the literature have examined adjuvant HAI after complete resection of liver metastases. Only one of these trials showed an overall survival benefit at 2 years but not over the entire time period of the study. Previous studies in patients with unresectable disease were plagued by high rates of biliary toxicity.
  
  
  METHODS
  A retrospective review of a prospectively maintained database was performed. Hepatic arterial pumps were placed in the standard fashion. Patients received floxuridine at doses previously demonstrated as safe in the literature. Standard statistical methods were used.
  
  
  RESULTS
  Twenty-one of 92 patients underwent placement of hepatic arterial pumps at the time of liver resection. The HAI group was similar in all demographic measures to the non-HAI group, with the exception that the HAI patients were significantly younger. No differences were seen between the groups in either disease-free or overall survival, although a trend toward improved hepatic progression-free survival was noted. Significant biliary sclerosis developed in six patients in the HAI group, requiring chronic indwelling stents in four patients. One patient died of progressive liver failure associated with this toxicity.
  
  
  CONCLUSIONS
  Biliary toxicity is an important potential side effect of hepatic arterial chemotherapy. Although larger randomized studies and this one suggest significant improvements in hepatic recurrences, these have not reliably translated into overall survival benefit. This fact, in light of the potential toxicity, would argue for a larger confirmatory trial of HAI in the adjuvant setting, incorporating recent advances in systemic therapy and careful attention to hepatotoxicity.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Onaitis
authors.forename: Michael
authors.initials: M
authors.lastname: Morse
authors.forename: Herbert
authors.initials: H
authors.lastname: Hurwitz
authors.forename: Peggy
authors.initials: P
authors.lastname: Cotton
authors.forename: Douglas
authors.initials: D
authors.lastname: Tyler
authors.forename: Pierre
authors.initials: P
authors.lastname: Clavien
authors.forename: Bryan
authors.initials: B
authors.lastname: Clary
mesh_terms: D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage; D006801:Humans; D007260:Infusion Pumps; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000964:Antimetabolites, Antineoplastic; D005467:Floxuridine