Regional infusion for colorectal hepatic metastases. A randomized trial comparing the hepatic artery with the portal vein
J. M. Daly, N. Kemeny, E. Sigurdson, P. Oderman and A. Thom
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York.
To evaluate which site of infusion maximizes tumor response to regional
hepatic chemotherapy, 25 patients were randomized preoperatively to receive
chemotherapy administration via hepatic artery or portal vein catheters. Of
the 25 patients, five did not have catheters placed due to extrahepatic
disease, and one patient did not receive infusion chemotherapy. Continuous
floxuridine infusion was given at a dosage of 0.3 mg/kg/d, alternating with
saline solution every two weeks. The mean percentage of hepatic tumor
replacement (36% vs 41%), mean serum alkaline phosphatase level (218 vs 179
IU/mL), and mean plasma carcinoembryonic antigen level (689 vs 563 ng/mL)
were similar in both groups. Four (50%) of eight hepatic artery patients
responded to treatment compared with 0/11 portal vein patients. Ten of 11
portal vein patients showed progressive tumor growth; nine of these
patients were crossed over to arterial infusion. Three (33%) of these nine
patients had an objective tumor response with the hepatic arterial
infusion. This prospective, randomized clinical trial demonstrates
significantly improved tumor response after hepatic arterial infusion
compared with portal vein infusion.
