title: Comparison of complete pathologic response and hepatic injuries between hepatic arterial infusion and systemic administration of oxaliplatin in patients with colorectal liver metastases.
abstract: BACKGROUND
  Whether hepatic arterial infusion (HAI) of oxaliplatin influences the rates of complete pathologic response (CPR) and severe oxaliplatin-related lesions (SOxL) in patients with colorectal liver metastases (CRLM) is unknown. This study aimed to compare the incidence of CPR and SOxL between systemic (intravenous, IV) and HAI administration.
  
  
  METHODS
  All patients with initially unresectable CRLM who had undergone hepatic resection in two expert centers between 2004 and 2010 after at least 6 cycles of oxaliplatin-based chemotherapy administered either via HAI (n = 18) or IV (n = 50) were included. The presence of CPR and SOxL were evaluated by two pathologists. A 1:2 case match using a propensity score was used.
  
  
  RESULTS
  A CPR was observed significantly more often after HAI (33 vs. 10 %, P = 0.03). However, SOxL had occurred more frequently in patients in the HAI group versus the IV group, 66 and 20 %, respectively (P < 0.001). On a well-balanced cohort, HAI was associated with higher chance of CPR (odds ratio 9.33, 95 % confidence interval 1.59-54.7) but also higher risk of SOxL (odds ratio 13.7, 95 % confidence interval 3.08-61.3). A CPR markedly enhanced overall survival (OS) and disease-free survival (median OS of 114 vs. 42 months, P = 0.02; median disease-free survival of 51 vs. 12 months, P = 0.002). Patients with SOxL did not experience different outcome (median OS of 42 vs. 50 months, respectively; P = 0.92) CONCLUSIONS: HAI of oxaliplatin increases the likelihood of a CPR at the cost of a higher incidence of SOxL in patients with initially unresectable CRLM.
authors.affiliation: Centre Hépato-biliaire, Paul Brousse Hospital, Villejuif Cedex, France.
authors.forename: Marc Antoine
authors.initials: MA
authors.lastname: Allard
authors.forename: Mylène
authors.initials: M
authors.lastname: Sebagh
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Baillie
authors.forename: Antoinette
authors.initials: A
authors.lastname: Lemoine
authors.forename: Peggy
authors.initials: P
authors.lastname: Dartigues
authors.forename: François
authors.initials: F
authors.lastname: Faitot
authors.forename: Matthieu
authors.initials: M
authors.lastname: Faron
authors.forename: Valérie
authors.initials: V
authors.lastname: Boige
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Vitadello
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
authors.forename: René
authors.initials: R
authors.lastname: Adam
authors.forename: Diane
authors.initials: D
authors.lastname: Goéré
authors.forename: Antonio
authors.initials: A
authors.lastname: Sa Cunha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011379:Prognosis; D015996:Survival Rate
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin