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Effect of hepatic artery chemotherapy on survival of patients with hepatic metastases from colorectal carcinoma treated with cryotherapy

Abstract

Thirty-eight patients with unresectable multiple liver metastases from colorectal carcinoma were treated with either hepatic artery chemotherapy (HAC) and cryotherapy (n=27) or cryotherapy alone (n=11). Follow-up survival data were summarized using Cox regression. Allowing for the effect of the pathology of the primary tumor and the preoperative carcinoembryonic antigen (CEA) level, those patients who did not receive HAC after cytoreduction were three times as likely to die as those given HAC (RR 3.3, 95%; CI 1.2–9.3). The estimated median survival of patients treated with cryotherapy alone was 245 days, whereas for those given more than 3 months of HAC plus cytoreduction therapy it was 570 days. It is recommended that all patients who receive cryotherapy for multiple liver metastases from colorectal rectal carcinoma be given subsequent hepatic artery chemotherapy.

Résumé

Trente-huit patients ayant des métastases hépatiques multiples non reséquables d'origine colorectale ont été traités soit par chimiothérapie par voie artérielle (CVA) associée à la cryothérapie (n=27) soit par cryothérapie seule (n=11). Les survies ont été analysées selon la méthode d'analyse du Modèle de Cox. En tenant compte de l'effet de la pathologie de la tumeur primitive et du niveau préopératoire de l'ACE, les patients n'ayant pas eu de de décéder que ceux qui en ont eu (RR 3.3, 95% IC 12 à 9.3). L'estimation de la survie médiane des patients traités par la cytoréduction seule a été de 245 jours, alors que celle des patients traités par les deux avec une CVA d'au moins trois mois, a été de 570 jours. On recommande que tous les patients ayant des métastases multiples du foie à partir des cancers colorectaux aient une CVA par la suite.

Resumen

En el presente estudio, 38 pacientes con metástasis hepáticas múltiples y no resecables de carcinoma colo-rectal fueron tratados con quimioterapia administrada en la arteria hepática (HAC) y crioterapia (n=27) o crioterapia sola (n=11). Los datos del seguimiento fueron resumidos según el método de regresión de Cox. Teniendo en cuenta el efecto de la patología del tumor primario y el nivel preoperatorio de antígeno carcino-embrionario, se halló que aquellos pacientes que no recibieron HAC luego de la citorreducción tuvieron una probabilidad de muerte 3 veces mayor que los que recibieron HAC (RR 3.3, 95% CI 1.2 a 9.3). La sobrevida media estimada de los pacientes tratados con crioterapia sola fue de 245 días, en tanto que aquellos que recibieron HAC por tres meses y terapia de citorreducción fue de 570 días. Se recomienda que todos los pacientes que reciben crioterapia para metástasis hepáticas múltiples de carcinoma colo-rectal reciban luego quimioterapia por vía de la arteria hepática.

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References

  1. 1.

    Hughes, K., Scheele, J., Sugarbaker, P.H.: Surgery for colorectal cancer metastatic to the liver optimizing the results of treatment. Surg. Clin. North Am. 69:339, 1989

  2. 2.

    Scheele, J., Stangl, R., Altendorf-Hofman, A.: Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br. J. Surg. 77:1241, 1990

  3. 3.

    Jaffe, B.M., Donegan, W.L., Watson, F., Spratt, J.S.: Factors influencing survival in patients with untreated hepatic metastases. Surg. Gynecol. Obstet. 127:1, 1968

  4. 4.

    Bengtsson, G., Carlsson, G., Hafstrom, L.O., Jonsson, P.E.: Natural history of patients with untreated liver metastases from colorectal cancer. Am. J. Surg. 141:586, 1981

  5. 5.

    Hohn, D., Stagg, R., Friedman, M., et al.: A randomized trial of continous intravenous versus hepatic intraarterial floxuridine in patients with colorectal cancer metastatic to the liver: the Northern California Oncology Group trial. J. Clin. Oncol. 7:1646, 1989

  6. 6.

    Chang, A.E., Schneider, P.D., Sugarbaker, P.H.: A prospective randomized trial of regional versus systemic continous 5-fluorodeoxyuridine chemotherapy in the treatment of colorectal liver metastases. Ann. Surg. 206:685, 1987

  7. 7.

    Martin, J.K., Jr. O'Connell, M.J., Wieand, H.S., et al.: Intra-arterial floxuridine versus systemic fluorouracil for hepatic metastases from colorectal cancer: a randomized trial. Arch. Surg. 125:1022, 1990

  8. 8.

    Rougier, P.H., Laplanche, A., Huguier, M., et al.: Hepatic arterial infusion of floxuridine in patients with liver metastases from colorectal carcinoma: long-term results of a prospective randomized trial. J. Clin. Oncol. 10:1112, 1992

  9. 9.

    Ravikumar, T.S., Kane, R., Cady, B.,et al. Hepatic cryotherapy with intraoperative ultrasound monitoring for metastatic colon carcinoma. Arch. Surg. 122:403, 1987

  10. 10.

    Zhou, X.D., Tang, Z.Y., Yu, Y-Q., Ma, Z-C.: Clinical evaluation of cryosurgery in the treatment of primary liver cancer. Cancer 197:375, 1988

  11. 11.

    Gilbert, J.C., Onik, G.M., Hoddick, W., Rubinsky, B.: Real time ultrasonic monitoring of hepatic cryosurgery. Cryobiology 22:319, 1985

  12. 12.

    Onik, G., Kane, R., Steele, G., et al.: Monitoring hepatic cryosurgery with sonography. A.J.R. Am. J. Roengenol. 147:665, 1986

  13. 13.

    Thomas, M., Morris, D.L., Hardcastle, J.D.: Contact ultrasound in the detection of liver metastases from colorectal cancer; an, in vitro study. Br. J. Surg. 74:955, 1987

  14. 14.

    Charnley, R.M., Morris, D.L., Dennison, A.R., Amar, S.S., Hardcastle, J.D.: Detection of colorectal liver metastases using intraoperative ultrasonography. Br. J. Surg. 78:45, 1991

  15. 15.

    Charnley, R.M., Thomas, M., Morris, D.L.: Effect of hepatic cryotherapy on serum CEA concentration in patients with multiple inoperable hepatic metastases from colorectal cancer. Aust. N.Z.J. Surg. 61:55, 1991

  16. 16.

    Onik, G., Rubinsky, B., Zemel, R., et al.: Ultrasound-guided hepatic cryosurgery in the treatment of metastatic colon carcinoma. Cancer 67:901, 1991

  17. 17.

    Ravikumar, T.S., Kane, R., Cady, B., et al.: A 5-year study of cryosurgery in the treatment of liver tumours. Arch. Surg. 126:1520, 1991

  18. 18.

    Dilley, A.V., Dy, D.Y., Warlters, A. et al.: Laboratory and animal model evaluation of the Cryotech, LCS 2000 in hepatic cryotherapy. Cryobiology 30:74, 1993

  19. 19.

    Goodie, D.B., Horton, M.D., Morris, R., Nagy, L.S., Morris, D.L.: The anaesthetic experience with hepatic cryotherapy for metastatic colonic carcinoma. Anaesthe. Intens. Care 20:491, 1992

  20. 20.

    Ardalan, B., Flores, M.G., Letter, J. Clin. Oncol. 11:384, 1993

  21. 21.

    Cox, D.R.: Regression models and life-tables J. R. Stat. Soc. [B] 34:187, 1972

  22. 22.

    Harrell, F.E., Lee, K.L.: Verifying assumptions of the Cox proportional hazards model. In Proceedings of the Eleventh Annual SAS Users Group International Conference, Atlanta, February 9–12, 1986 Cary, NC, SAS Institute, 1986, pp. 823–828

  23. 23.

    Kleinbaum, D.G., Kupper, L.L., Muller, K.E.: Applied Regression Analysis and Other Multivariate Methods, Boston, PWS-Kent, 1988

  24. 24.

    Kemeny, N.E.: Is hepatic infusion of chemotherapy effective treatment for liver metastases? Yes! In Important Advances in Oncology, 1992. V.T. De Vita, Jr., S. Hellmen, S.A. Rosenberg, editors, Philadelphia, Lippincott, 1992, pp. 207–227

  25. 25.

    Hunt, T.M., Flowerdew, A.D.S., Birch, S.J., et al.: Prospective randomized controlled trial of hepatic arterial embolization or infusion chemotherapy with 5-fluorouracil and degradable starch microspheres for colorectal liver metastases. Br. J. Surg. 77:779, 1990

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Preketes, A.P., Caplehorn, J.R.M., King, J. et al. Effect of hepatic artery chemotherapy on survival of patients with hepatic metastases from colorectal carcinoma treated with cryotherapy. World J. Surg. 19, 768–771 (1995). https://doi.org/10.1007/BF00295928

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Keywords

  • Carcinoma
  • Median Survival
  • Colorectal Carcinoma
  • Survival Data
  • Hepatic Metastasis