Intra arterial hepatic chemotherapy for unresectable colorectal metastases: (review).
BACKGROUND
Hepatic arterial infusion (HAI) chemotherapy is based on the idea that liver metastases are perfused almost exclusively by the hepatic artery. This approach has been extensively investigated in 1970s and 1980s. Currently, there is a worldwide growing interest in intraarterial therapeutic approaches for hepatic metastases. The principal aim of this review was to define current role of HAI in the management of metastatic colorectal cancer.


METHODS
Data for this review were identified by searches of MEDLINE using the search terms "hepatic arterial infusion", "colorectal cancer" and "chemotherapy". Abstracts and reports from meetings were included only when they related directly to previously published work. Only papers published in English between 1966 and 2005 were included.


CONCLUSIONS
There are 10 published randomised clinical trials comparing fluoropyrimidine-based HAI with systemic route. Two meta-analyses of the earlier 7 trials confirmed a statistically significant response rate and improved disease-free survival with HAI. However, the cost and complication rates were of primary concern. The last decade witnessed the introducztion of new chemotherapeutic regimens including biologically targeted agents for the management of metastatic colorectal cancer patients and advancement in radiological and surgical techniques. These led to reconsideration of HAI-based therapeutic modalities with many running trials addressing its value in this new era. The results of these trials may help to clarify the role of HAI in the near future.
Abdulaal
Y
Y
The Liver Transplant Unit, Institute of Liver Studies, King's College Hospital, London, UK.
Ross
P
P
Heaton
N
N
D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic
D000970:Antineoplastic Agents