Survival of patients with colorectal cancer liver metastases treated by regional chemotherapy.
OBJECTIVE
Liver is the most common site of metastatic disease in colorectal cancer. Superior response rate was demonstrated in trials comparing hepatic arterial administration of cytotoxic agents with systemic chemotherapy.


METHODS
Records of 109 consecutive patients with colorectal carcinoma metastatic to the liver treated by regional chemotherapy, who underwent implantation of a port system into hepatic artery or portal vein tributaries between 1991 and 1999, were reviewed and survival was evaluated using the log-rank test and multivariate analysis (Cox's proportional hazard regression).


RESULTS
The median survival from diagnosis was 24 months. Survival was significantly longer for patients treated by radical resection, and patients treated in 1997-1999. On multivariate analysis, treatment by 6 or more chemotherapy cycles, stage 1 liver metastases, treatment with irinotecan and radical resection were associated with better survival, while the presence of extrahepatic disease had an adverse effect on the risk of death. Extrahepatic spread was subsequently detected in almost half of the patients who had originally isolated liver metastases.


CONCLUSIONS
Patients treated by liver resection had the best outcome, while patients with extrahepatic diseases had poor prognosis. The prognosis of patients treated by regional chemotherapy improved significantly with the advent of irinotecan and better selection.
Melichar
Bohuslav
B
Department of Oncology and Radiotherapy, Charles University Medical School Teaching Hospital, Building 23, 500 05 Hradec Králové, Czech Republic. melichar@fnhk.cz
Voboril
Zbynek
Z
Cerman
Jaroslav
J
Melicharová
Karolina
K
Mergancová
Jindriska
J
Voboril
René
R
Jandík
Pavel
P
D018943:Anthracyclines / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D002408:Catheters, Indwelling; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D000077146:Irinotecan; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000627:therapeutic use; D011169:Portal Vein; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
D018943:Anthracyclines; D000970:Antineoplastic Agents; D016685:Mitomycin; D000077146:Irinotecan; D002166:Camptothecin