TACE of liver metastases from colorectal cancer adopting irinotecan-eluting beads: beneficial effect of palliative intra-arterial lidocaine and post-procedure supportive therapy on the control of side effects.
OBJECTIVE
Colorectal cancer is one of the most significant health emerging problem in western countries. Patients with colorectal cancer have liver metastases at presentation in about 25% of cases and another 50% will develop liver recurrence within the next 5 years. Intra-arterial hepatic chemoembolization (TACE) could be a new therapeutic opportunity in the treatment of unresectable or chemorefractory metastases.


METHODS
Since November 2005 we performed a clinical trial of TACE with irinotecan-eluting beads (DEBIRI) in 20 patients affected by liver metastases from colorectal cancer as palliative setting. We developed an intensive treatment with intra-arterial lidocaine and post-procedure supportive therapy to reduce acute toxic effects


RESULTS
We observed a high response rate (80%), with reduction of lesional contrast enhancement in all responding patients. Due to the supportive treatment, TACE was well tolerated by most patients with a median duration of hospitalization of 3 days (range 1-10). The most important adverse event was abdominal pain. Supportive treatment with antibiotic and antiemetic prophylaxis, and intravenous hydratation is strictly necessary until stabilization of serum levels of transaminases and to prevent infections. Major analgesic as morphine and intra-arterial lidocaine must be used before the procedure.


CONCLUSIONS
Our results suggest that TACE using DEBIRI feasible in pretreated patients with liver metastases from CRC adopting an adequate supportive therapy to reduce side effects.
Fiorentini
Giammaria
G
Department of Oncology, San Giuseppe Hospital, Azienda Sanitaria Locale 11, Empoli, Florence, Italy. oncologiaempoli@usl11.tos.it
Aliberti
Camillo
C
Benea
Giorgio
G
Montagnani
Francesco
F
Mambrini
Andrea
A
Ballardini
Pier Luigi
PL
Cantore
Maurizio
M
D015746:Abdominal Pain / Q000209:etiology; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016461:Chemoembolization, Therapeutic; D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D007261:Infusions, Intra-Arterial; D000077146:Irinotecan; D008012:Lidocaine / Q000008:administration & dosage*; D008113:Liver Neoplasms / Q000628:therapy*; D008863:Microspheres; D010166:Palliative Care; D011788:Quality of Life; D016896:Treatment Outcome
D000972:Antineoplastic Agents, Phytogenic; D000077146:Irinotecan; D008012:Lidocaine; D002166:Camptothecin