title: Systematic review and meta-analysis of hepatic arterial infusion chemotherapy as bridging therapy for colorectal liver metastases.
abstract: BACKGROUND
  Hepatic arterial infusion chemotherapy (HAIC) has been shown to be beneficial in the management of unresectable colorectal liver metastases (CRLM). This systematic review evaluates the potential role of HAIC as a neoadjuvant downstaging therapy, prior to hepatic resection with curative intent for initially unresectable CRLM.
  
  
  METHODS
  A literature search was conducted using Pubmed, EMBASE and Medline databases from January 2000 to November 2013. Studies adopting HAIC as a neoadjuvant bridging therapy for hepatic resection for CRLM were included.
  
  
  RESULTS
  Eleven studies (n = 1514) were included. HAIC response rate was 50% and achieved conversion to surgery rate in 18% of patients. The median overall and 5-year survival for patients who underwent conversion to hepatectomy was 53 months and 49% compared to 16 months and 3% for patients who did not undergo surgery. Meta-analysis demonstrated strong association between hepatectomy and improved 5-year survival (RR 0.56, 95% CI = 0.48-0.65, Z = 7.26, p < 0.00001).
  
  
  CONCLUSIONS
  For patients presenting with unresectable CRLM, HAIC in conjunction with current systemic chemotherapy may allow some patients to undergo resection and potentially provide long-term survival.
authors.affiliation: The Systematic Review Unit, The Collaborative Research (CORE) Group, Kogarah, NSW, Australia.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Chan
authors.affiliation: The Systematic Review Unit, The Collaborative Research (CORE) Group, Kogarah, NSW, Australia.
authors.forename: Nayef A
authors.initials: NA
authors.lastname: Alzahrani
authors.affiliation: UNSW Department of Surgery, St George Clinical School, Kogarah, NSW, Australia.
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
authors.affiliation: Department of Surgery, Ryde Hospital, Northern Sydney Local Health District, Denistone, NSW, Australia; The Systematic Review Unit, The Collaborative Research (CORE) Group, Kogarah, NSW, Australia. Electronic address: terence.c.chua@gmail.com.
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D011379:Prognosis
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Colorectal carcinoma; Hepatic artery; Liver metastases; Neoadjuvant; Systematic review: meta-analysis