title: Conversion to complete resection and/or ablation using hepatic artery infusional chemotherapy in patients with unresectable liver metastases from colorectal cancer: a decade of experience at a single institution.
abstract: BACKGROUND
  When feasible, surgical treatment of colorectal liver metastases (CRLM) is the treatment of choice. Regional hepatic artery infusional (HAI) chemotherapy effectively treats CRLM. The combination of HAI and systemic chemotherapy may downsize tumors and allow for complete resection and/or ablation (R/A). This study analyzes the combination of HAI and systemic chemotherapy for treating unresectable CRLM, focusing on conversion to complete R/A.
  
  
  METHODS
  All patients with unresectable CRLM treated with HAI and systemic chemotherapy from 2000 to 2009 were included. Patients who responded sufficiently to undergo complete R/A were compared to those who did not convert. Survival was compared using a landmark analysis to account for bias.
  
  
  RESULTS
  A total of 373 patients were included; 93 patients (25%) subsequently underwent complete R/A. The percentage of patients submitted to complete R/A increased from 16% during 2000-2003 to 30% during 2004-2009. Factors associated with conversion on multivariate analysis were more recent treatment (2004-2009), no prior chemotherapy, clinical risk score<3, treatment on clinical protocol, and younger age. Median and predicted 5-year survival from the time of HAI pump placement was 59 months and 47%, respectively, in the patients who converted to complete R/A, compared with 16 months and 6%, respectively in those who did not (p<0.001).
  
  
  CONCLUSIONS
  Despite extensive disease, 25% of patients with unresectable CRLM responded sufficiently to undergo complete R/A following HAI plus systemic chemotherapy. Combination HAI and systemic chemotherapy is an effective strategy to convert patients to complete resection with an associated excellent long-term survival.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. john.ammori@uhhospitals.org
authors.forename: John B
authors.initials: JB
authors.lastname: Ammori
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Kemeny
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.forename: Andrea
authors.initials: A
authors.lastname: Cercek
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Dematteo
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Philip B
authors.initials: PB
authors.lastname: Paty
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017115:Catheter Ablation / Q000401:mortality; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D055815:Young Adult