Extensive liver metastasis of gastric cancer effectively treated by hepatic arterial infusion of 5-fluorouracil/cisplatin

Abstract

Most gastric cancer patients with jaundice caused by extensive liver metastasis show no tumor shrinkage response to systemic chemotherapy, while often showing severe adverse reactions. Their prognosis is very poor. We experienced two patients for whom hepatic arterial infusion (HAI) of 5-fluorouracil (5-FU) and cisplatin through an implantable port was effective for treating extensive liver metastasis. One patient had jaundice (serum bilirubin level before HAI therapy, 12.4 mg/dl) caused by metachronous liver metastasis, and prior systemic chemotherapy with 5-FU and irinotecan had not been effective. The other patient had gastric cancer with synchronous liver metastasis and also exhibited jaundice (serum bilirubin level before HAI therapy, 11.8 mg/dl). Both patients were treated with HAI of cisplatin, 20 mg/m(2) for 30 min on day 1, and continuous intraarterial infusion of 5-FU, 300 mg/m(2), from day 1 to day 4 every week. Their metastatic liver tumors were significantly reduced in volume and the jaundice disappeared. They survived for 30 and 27 weeks, respectively. A pharmacokinetic study conducted during the period of partial remission revealed that the extraction ratios of 5-FU and cisplatin in the liver were 0.89 and 0.024, respectively, suggesting a favorable first-pass effect of 5-FU. Although our findings here suggest that the successful local control of liver metastasis could improve the deteriorated condition and prolong the survival in some patients with far advanced cancer, it is essential to pay much attention to possible adverse effects during the treatment.

Ellagic acid ameliorates cisplatin induced hepatotoxicity in colon carcinogenesis

“…Atypical cells were also seen in CP + EA cotreated group but to a lesser extent than DMH + CP alone group. Clinical evidence of CP‐induced liver injury has been demonstrated by elevated activities of serum enzymes . Cell death can result from naturally occurring apoptosis (physiological apoptosis) or from irreparable cell injury (pathological apoptosis) and manifests in the form of altered histoarchitecture as evident in our results.…”

Outcomes for patients following hepatic resection of metastatic tumors from gastric cancer

“…Nonsurgical intervention methods including hepatic arterial infusion (HAI) [20][21][22], systemic chemotherapy U upper third of the stomach, M middle third of the stomach, L lower third of the stomach [9,23], and radiofrequency ablation (RFA) have been reported to produce clinical benefits for patients with hepatic metastases from gastric cancer [24]. However, the MST of patients who received HAI was 19.2 months, and only 5.6% survived for more than 5 years [22].…”

Histopathological effects of cisplatin, doxorubicin and 5-flurouracil (5-FU) on the liver of male albino rats

“…The liver is known to accumulate significant amounts of cisplatin, second only to the kidney 21, thus hepatotoxicity can be associated with cisplatin treatment 22. Clinical evidence of cisplatin-induced liver injury has been demonstrated by elevated activities of serum enzymes and bilirubin levels, and the development of jaundice 23. Cell death can result from naturally occurring apoptosis (physiological apoptosis) or from irreparable cell injury (pathological apoptosis) as described by Farber (1994) 24.…”