title: Hepatic Arterial Infusion in Combination with Modern Systemic Chemotherapy is Associated with Improved Survival Compared with Modern Systemic Chemotherapy Alone in Patients with Isolated Unresectable Colorectal Liver Metastases: A Case-Control Study.
abstract: BACKGROUND
  In the era of effective modern systemic chemotherapy (CT), the role of hepatic arterial infusion of fluoxuridine (HAI-FUDR) in the treatment of isolated unresectable colorectal liver metastasis (IU-CRCLM) remains controversial. This study aimed to compare the overall survival (OS) of HAI-FUDR in combination with modern systemic CT versus modern systemic CT alone in patients with IU-CRCLM.
  
  
  METHODS
  This was a case-control study of IU-CRCLM patients who underwent HAI + modern systemic CT or modern systemic CT alone. Modern systemic CT was defined as the use of multidrug regimens containing oxaliplatin and/or irinotecan ± biologics.
  
  
  RESULTS
  Overall, 86 patients met the inclusion criteria (n = 40 for the HAI + CT group, and n = 46 for the CT-alone group). Both groups were similar in demographics, primary and stage IV tumor characteristics, and treatment-related variables (carcinoembryonic antigen, use of biologic agents, total number of lines of systemic CT administered) (all p > 0.05). Additionally, both groups were comparable with respect to liver tumor burden [median number of lesions (13.5 vs. 15), percentage of liver tumor replacement (37.5 vs. 40 %), and size of largest lesion] (all p > 0.05). Median OS in the HAI + CT group was 32.8 months compared with 15.3 months in the CT-alone group (p < 0.0001). Multivariate analysis revealed HAI + CT (hazard ratio 0.4, 95 % confidence interval 0.21-0.72; p = 0.003), Eastern Cooperative Oncology Group status, and receipt of increasing number of lines of systemic CT to be independent predictors of survival.
  
  
  CONCLUSIONS
  In this case-control study of patients with IU-CRCLM, HAI in combination with CT was associated with improved OS when compared with modern systemic CT alone.
authors.affiliation: Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Mashaal
authors.initials: M
authors.lastname: Dhir
authors.affiliation: Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Jones
authors.affiliation: Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Yongli
authors.initials: Y
authors.lastname: Shuai
authors.affiliation: Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Amber K
authors.initials: AK
authors.lastname: Clifford
authors.affiliation: Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Perkins
authors.affiliation: Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steve
authors.affiliation: Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hogg
authors.affiliation: Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: M Haroon A
authors.initials: MH
authors.lastname: Choudry
authors.affiliation: Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Pingpank
authors.affiliation: Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Holtzman
authors.affiliation: Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.affiliation: Department of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Bahary
authors.affiliation: Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.affiliation: Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. zureikatah@upmc.edu.
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D000077146:Irinotecan; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D009944:Organoplatinum Compounds; D005467:Floxuridine; D000077150:Oxaliplatin; D000077146:Irinotecan; D002166:Camptothecin