Chemoembolization of colorectal liver metastases with cisplatin, doxorubicin, mitomycin C, ethiodol, and polyvinyl alcohol

Abstract

BACKGROUND: Unresectable colorectal liver metastases have a 1-and 2-year survival of 55% and 33% with current systemic therapies. The authors evaluated response and survival after transarterial chemoembolization. METHODS: Chemoembolization with cisplatin, doxorubicin, mitomycin C, ethiodized oil, and polyvinyl alcohol particles was performed at monthly intervals for 1 to 4 sessions. Cross-sectional imaging and clinical and laboratory evaluation were performed before treatment, 1 month after treatment, and then every 3 months. A second cycle was performed for intrahepatic recurrence. Toxicity was assessed using National Cancer Institute's Common Toxicity Criteria version 3.0. Response was evaluated using Response Evaluation Criteria in Solid Tumors criteria. Progression and survival were estimated with Kaplan-Meier analysis. RESULTS: A total of 245 treatments were performed over 141 cycles on 121 patients. Ninety-five of 141 treatment cycles were evaluable for response: 2 (2%) partial response, 39 (41%) stable disease, and 54 (57%) progression. Median time to disease progression (TTP) in the treated liver was 5 months, and median TTP anywhere was 3 months. Median survival was 33 months from diagnosis of the primary colon cancer, 27 months from development of liver metastases, and 9 months from chemoembolization. Survival was significantly better when chemoembolization was performed after first-or second-line systemic therapy (11-12 months) than after third-to fifth-line therapies (6 months) (P ¼ .03). Presence of extrahepatic metastases did not adversely affect survival (P ¼ .48). CONCLUSIONS: Chemoembolization provided local disease control of hepatic metastases after 43% of treatment cycles. Median survival was 27 months overall, and 11 months when initiated for salvage after failure of second-line systemic therapy. Cancer 2011;117:343-52.

Transarterial chemoembolization of unresectable systemic chemotherapy‐refractory liver metastases from colorectal cancer: Long‐term results over a 10‐year period

“…The results of Wasser et al almost coincide with our study results, in which median survival was 13.9 months for the mitomycin and gemcitabine group and 14 months for the mitomycin only and mitomycin and irinotecan groups. In the study of Albert et al, 35 121 patients underwent chemoembolization with cisplatin, doxorubicin, mitomycin C, ethiodized oil and polyvinyl alcohol particles. All patients had treatment at monthly intervals for one to four sessions.…”

Current strategies in interventional oncology of colorectal liver metastases

“…10 It generally includes multiple procedures in a 4-to 6-week interval. CT/MRT is used to evaluate the results of the procedures (Figure 1).…”

“…Most common effects of post-embolization syndrome are pain, nausea, vomiting and fatigue. 7,10 Post-embolization pain represents one of the most common side effects of chemoembolization. Intra-arterial injection of lidocaine has been reported to reduce the severity and duration of postembolization pain.…”

“…7,10 Several previous studies addressed the safety of performing TACE on an outpatient basis. Mitchell et al 20 reported the safety of the outpatient concept in carefully selected patients, where 131 from 133 sessions were performed on outpatient cases and only 2 required readmission.…”

Interventional oncology: the future

“…The advantage of combined chemotherapy and embolization is that the arterial administration concentrates the chemotherapy and the embolization increases the dwell time at the target with less systemic effect than intravenous or oral chemotherapy. TACE has been widely used for hepatic colon cancer metastases [14] and hepatocellular carcinoma where the embolic material may be ethiodol, particles, or chemotherapy-eluding beads [15]. TACE has decreased hepatic-prevented progression facilitating orthotopic liver transplantation (OLT) [16].…”