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Selective Intra-arterial Chemotherapy with Floxuridine as Second- or Third-Line Approach in Patients with Unresectable Colorectal Liver Metastases

Authors
  • Samaras, Panagiotis1
  • Breitenstein, S.1
  • Haile, S. R.2
  • Stenner-Liewen, F.1
  • Heinrich, S.1
  • Feilchenfeldt, J.1
  • Renner, C.1
  • Knuth, A.1
  • Pestalozzi, B. C.1
  • Clavien, P. A.1
  • 1 University Hospital Zurich, Swiss HPB (Hepato-Pancreatico-Biliary) Center, Departments of Oncology and Surgery, Zurich, Switzerland , Zurich (Switzerland)
  • 2 Institute of Social and Preventive Medicine University of Zurich, Biostatistics Unit, Zurich, Switzerland , Zurich (Switzerland)
Type
Published Article
Journal
Annals of Surgical Oncology
Publisher
Springer - Society of Surgical Oncology
Publication Date
Jan 05, 2011
Volume
18
Issue
7
Pages
1924–1931
Identifiers
DOI: 10.1245/s10434-010-1505-2
Source
Springer Nature
Keywords
License
Yellow

Abstract

BackgroundAn outcome assessment was performed of patients with unresectable colorectal liver metastases (CRLM) treated in second or third line with floxuridine (FUDR)-based hepatic artery infusion (HAI).MethodsTwenty-three patients who were pretreated with systemic (immuno)chemotherapy received FUDR-HAI alone or combined with systemic chemotherapy. We reviewed patient charts and our prospective patient database for survival and associated risk factors.ResultsPatients received FUDR-HAI for unresectable CRLM from January 2000 to September 2010. Twelve patients (52%) received concurrent systemic chemotherapy. Median overall survival (OS), progression-free survival (PFS), and hepatic PFS were 15.6 months (range, 2.5–55.7 months), 3.9 months (range, 0.7–55.7 months), and 5.5 months (range, 1.6–55.7 months), respectively. The liver resection rate after HAI was 35%. PFS was better in patients undergoing secondary resection than in patients without resection (hazard ratio [HR] 0.21; 95% confidence interval [95% CI] 0.07–0.66; P = 0.0034), while OS showed a trend toward improvement (HR 0.4; 95% CI 0.13–1.2; P = 0.09). No differences were observed in OS (P = 0.69) or PFS (P = 0.086) in patients who received FUDR-HAI alone compared with patients treated with combined regional and systemic chemotherapy. No statistically significant differences were seen in patients previously treated with one chemotherapy line compared with patients treated with two lines. Presence of extrahepatic disease was a negative risk factor for PFS (liver-only disease: HR 0.03; 95% CI 0.0032–0.28; P < 0.0001). Toxicities were manageable with dose modifications and supportive measures.ConclusionsFUDR-HAI improves PFS and results in a trend toward improved OS in selected patients able to undergo liver resection after tumor is downsized.

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