title: Biliary sclerosis after hepatic arterial infusion pump chemotherapy for patients with colorectal cancer liver metastasis: incidence, clinical features, and risk factors.
abstract: BACKGROUND
  Hepatic arterial infusion pump chemotherapy (HAIPC) contributes to the prolonged survival of selected patients with colorectal cancer liver metastases (CRCLM). The most clinically important adverse event after HAIPC with floxuridine (FUDR) is biliary sclerosis (BS). Little is known about the etiology of BS.
  
  
  METHODS
  HAIPC was administered to 475 consecutive patients who received HAIPC on prospective protocols from 1991 to 2008. The incidence, clinical features, variables related to demographics, comorbidity, medical history, CRCLM, surgery, chemotherapy, and laboratory data were reviewed. An analysis of factors potentially associated with BS, defined as a biliary stricture related to HAIPC requiring stent placement, was performed.
  
  
  RESULTS
  The incidence of BS was 5.5% (16 of 293) in patients receiving HAIPC as an adjuvant therapy after hepatectomy, and 2% (2 of 100) in patients receiving HAIPC with FUDR for unresectable disease. The common hepatic duct was the site most frequently affected (87.5%). In patients receiving adjuvant HAIPC, BS was associated with abnormal postoperative flow scans (18.8% vs. 1.8%, P = 0.006), postoperative infectious complications (50.0% vs. 14.8%, P = 0.002), and larger dose/cycle/weight of FUDR (2.6 vs. 2.0 mg/cycle/kg, P = 0.025) than patients without BS. No patient died directly of BS. Median survival was not compromised by the development of BS (BS vs. non-BS: 61.0 months [range 6.2-171.6 months] vs. 47.2 months [range 2.4-200.8 months], P = 0.316, respectively).
  
  
  CONCLUSIONS
  BS is an uncommon complication after HAIPC and does not compromise survival if adequately salvaged by stenting or dilatation. Surgical complications as well as type and dose of intra-arterial chemotherapy may contribute to the development of BS.
authors: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Kaori
authors: K
authors: Ito
authors: Hiromichi
authors: H
authors: Ito
authors: Nancy E
authors: NE
authors: Kemeny
authors: Mithat
authors: M
authors: Gonen
authors: Peter J
authors: PJ
authors: Allen
authors: Philip B
authors: PB
authors: Paty
authors: Yuman
authors: Y
authors: Fong
authors: Ronald P
authors: RP
authors: Dematteo
authors: Leslie H
authors: LH
authors: Blumgart
authors: William R
authors: WR
authors: Jarnagin
authors: Michael I
authors: MI
authors: D'Angelica
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D015984:Causality; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D015897:Comorbidity; D004106:Dilatation / Q000379:methods; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage* / Q000009:adverse effects; D006498:Hepatectomy; D006801:Humans; D006932:Hyperbilirubinemia / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007261:Infusions, Intra-Arterial / Q000009:adverse effects / Q000706:statistics & numerical data*; D008026:Ligation / Q000009:adverse effects; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage* / Q000009:adverse effects; D015607:Stents; D015996:Survival Rate; D055815:Young Adult
chemical_list: D005467:Floxuridine; D016685:Mitomycin