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Downstaging of hepatocellular carcinoma and liver metastases from colorectal cancer by selective intra-arterial chemotherapy.

Publication ,  Journal Article
Clavien, P-A; Selzner, N; Morse, M; Selzner, M; Paulson, E
Published in: Surgery
April 2002

BACKGROUND: Although resection is the sole chance of cure in patients with hepatocellular carcinoma (HCC) or metastatic colorectal cancer to the liver, most patients are not candidates for surgery at the time of diagnosis. Strategies aiming at downstaging large or multifocal tumors to enable curative resection are appealing. The aim of this study was to evaluate the effects of neoadjuvant selective intra-arterial chemotherapy in noncirrhotic patients with unresectable HCC or metastatic colorectal cancer to the liver in the absence of extrahepatic disease. METHODS: Selective chemotherapy was provided by using a subcutaneous pump device via a catheter placed in the gastroduodenal artery. Chemotherapy regimen included floxuridine (0.2 mg/kg/day for 14 days) in each patient with additional boluses of cisplatin and doxorubicin on day 1 of each cycle in the presence of HCC. Patients were evaluated at 3, 6, 9, and 12 months for possible curative resection. Complete follow-up was available for each patient. RESULTS: Twenty-eight patients with unresectable liver tumors (5 HCC and 23 metastatic colorectal cancer) were included in this study. There were no surgical complications related to pump insertion, and local chemotherapy was started within 1 week of surgery in each patient. The median follow-up in survivors was 31 months (range, 30 months to 5 years). Chemotherapy was well tolerated in 18 (64%) patients. Chemotherapy was discontinued in 4 patients because of abnormal liver function test results, and 2 of them required a biliary stent to relieve a biliary stricture. In 9 patients downstaging enabled curative resection (3 HCC, 6 colorectal metastasis). Seven of these patients were alive and tumor free at the completion of the study, with at least 2 years of follow-up. The actuarial survival rates at 3 years for HCC and colorectal metastases were 60% and 50%, respectively. CONCLUSIONS: About one third of patients with unresectable liver tumors can be successfully treated by neoadjuvant intra-arterial chemotherapy followed by curative resection. This strategy appears particularly promising in patients with large HCC. This approach should be investigated further.

Duke Scholars

Published In

Surgery

DOI

ISSN

0039-6060

Publication Date

April 2002

Volume

131

Issue

4

Start / End Page

433 / 442

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Surgery
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Liver Neoplasms
  • Infusions, Intra-Arterial
  • Infusion Pumps
  • Humans
  • Floxuridine
 

Citation

APA
Chicago
ICMJE
MLA
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Clavien, P.-A., Selzner, N., Morse, M., Selzner, M., & Paulson, E. (2002). Downstaging of hepatocellular carcinoma and liver metastases from colorectal cancer by selective intra-arterial chemotherapy. Surgery, 131(4), 433–442. https://doi.org/10.1067/msy.2002.122374
Clavien, Pierre-Alain, Nazia Selzner, Michael Morse, Markus Selzner, and Eric Paulson. “Downstaging of hepatocellular carcinoma and liver metastases from colorectal cancer by selective intra-arterial chemotherapy.Surgery 131, no. 4 (April 2002): 433–42. https://doi.org/10.1067/msy.2002.122374.
Clavien P-A, Selzner N, Morse M, Selzner M, Paulson E. Downstaging of hepatocellular carcinoma and liver metastases from colorectal cancer by selective intra-arterial chemotherapy. Surgery. 2002 Apr;131(4):433–42.
Clavien, Pierre-Alain, et al. “Downstaging of hepatocellular carcinoma and liver metastases from colorectal cancer by selective intra-arterial chemotherapy.Surgery, vol. 131, no. 4, Apr. 2002, pp. 433–42. Pubmed, doi:10.1067/msy.2002.122374.
Clavien P-A, Selzner N, Morse M, Selzner M, Paulson E. Downstaging of hepatocellular carcinoma and liver metastases from colorectal cancer by selective intra-arterial chemotherapy. Surgery. 2002 Apr;131(4):433–442.
Journal cover image

Published In

Surgery

DOI

ISSN

0039-6060

Publication Date

April 2002

Volume

131

Issue

4

Start / End Page

433 / 442

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Surgery
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Liver Neoplasms
  • Infusions, Intra-Arterial
  • Infusion Pumps
  • Humans
  • Floxuridine