Management of isolated nonresectable liver metastases in colorectal cancer patients: a case-control study of isolated hepatic perfusion with melphalan versus systemic chemotherapy.
BACKGROUND
To compare the median overall survival of patients with isolated nonresectable liver metastases in comparable groups of patients treated with either isolated hepatic perfusion (IHP) with melphalan or systemic chemotherapy.


METHODS
Colorectal cancer patients with isolated liver metastases, who underwent IHP, were included in this study. The control group consisted of a subgroup of colorectal cancer patients with liver metastases only, who were enrolled in the randomized CApecitabine, IRinotecan, Oxaliplatin (CAIRO) phase III study.


RESULTS
Ninety-nine patients were treated with IHP, and 111 patients were included in the control group. All patient characteristics were comparable except for age. Median follow-up was 78.1 months for IHP versus 54.7 months in the control group. Median overall survival was 25.0 [95% confidence interval (CI) 19.4-30.6] months for IHP and 21.7 (95% CI 19.6-23.8) months for systemic treatment and did not differ significantly (P = 0.29). Treatment-related mortality was 2% for the systemic treatment and 6% for IHP (P = 0.11).


CONCLUSIONS
Compared with a patient group with comparable characteristics treated with systemic chemotherapy, IHP does not provide a benefit in overall survival in patients with isolated nonresectable colorectal liver metastases. Currently, the use of IHP cannot be advocated outside the scope of clinical studies.
van Iersel
L B J
LBJ
Department of Clinical Oncology, Leiden University Medical Center, Leiden.
Koopman
M
M
Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen.
van de Velde
C J H
CJH
Department of Surgery, Leiden University Medical Center, Leiden.
Mol
L
L
Comprehensive Cancer Centre East (IKO), Nijmegen.
van Persijn van Meerten
E L
EL
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Hartgrink
H H
HH
Department of Surgery, Leiden University Medical Center, Leiden.
Kuppen
P J K
PJK
Department of Surgery, Leiden University Medical Center, Leiden.
Vahrmeijer
A L
AL
Department of Surgery, Leiden University Medical Center, Leiden.
Nortier
J W R
JWR
Department of Clinical Oncology, Leiden University Medical Center, Leiden.
Tollenaar
R A E M
RAEM
Department of Surgery, Leiden University Medical Center, Leiden.
Punt
C
C
Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen.
Gelderblom
H
H
Department of Clinical Oncology, Leiden University Medical Center, Leiden. Electronic address: a.j.gelderblom@lumc.nl.
D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D010478:Chemotherapy, Cancer, Regional Perfusion; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged
D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan