Management of patients with unresectable liver metastases from colorectal and gastric cancer employing an implantable port system

Abstract

Between 1985 and 1990, 50 patients with unresectable liver metastases from colorectal cancer and 34 subjects with metastases from gastric cancer were treated by repeated hepatic arterial infusion chemotherapy employing an implantable prot system. A catheter was inserted into the hepatic artery via the left subclavian artery and was connected to the implantable injection port in each patient. 5-Fluorouracil (5-FU) at 330 mg/m2 per week (167 mg/m2 daily given continuously over the initial 3 months for colorectal cancer), Adriamycin (ADR) at 20 mg/m2 every 4 weeks and mitomycin C (MMC) at 2.7 mg/m2 every 2 weeks were given to all 34 patients with gastric cancer and to 31 of the colorectal cancer patients. The remaining 19 patients with colorectal cancer received 5-FU at 1,000 mg/m2 every week. As a rule the treatment was performed on an outpatient basis. The side effects and complications observed included myelosuppression (23%), hepatic arterial occlusion (21%), and gastroduodenal mucositis (12%), although no major toxicity was encountered. The response rate (CR+PR) among the evaluated patients as determined using CT scans was 67% for colorectal cancer and 73% for gastric cancer. The overall median survival was 12 months and 15 months, respectively. Good local control of liver metastases from the colorectal and gastric cancers was achieved by repeated hepatic arterial infusion chemotherapy employing an implantable port system without the need for hospitalization and without producing major toxicity. Thus, the implantable port system is very useful for the management of patients with unresectable liver metastases.

Favorable indications for hepatectomy in patients with liver metastasis from gastric cancer

“…Of the 37 patients, 21 had a solitary tumor and 16 had multiple (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) tumors. The distribution of the tumors was unilobar in 30 patients and bilobar in 7 patients.…”

“…These results suggest the extreme difficulty of obtaining surgical cure in patients with LMGC, and also the necessity of better patient selection and effective adjuvant chemotherapy in order to prolong the patients' survival. As the median overall survival time following hepatectomy in patients with multiple, bilobar metastasis or positive surgical margin was shorter than the median overall survival time of patients administered some effective chemotherapeutic regimens [4,8] (Table I), strict patient selection and informed consent from the patients would be mandatory.…”

“…Surgical resection of liver metastasis from gastric cancer (LMGC) is rarely indicated, because LMGC is often associated with extrahepatic disease, such as peritoneal dissemination, lymph node metastasis, and direct cancer invasion of other organs [1]. Most of the patients with LMGC are thus treated by systemic administration or hepatic arterial infusion of 5-FU, adriamycin, mitomycin C (MMC), cisplatin, and/or S-1 [3][4][5][6][7][8][9] (Table I). The response rates and median overall survival time of patients treated with chemotherapeutic regimens have been reported to be 25-73% and 7-15 months, respectively, and the longterm survival is dismal.…”

Colorectal liver metastases: regional chemotherapy via transarterial chemoembolization (TACE) and hepatic chemoperfusion: an update

“…Also, embolization is useful in the presence of an associated vascular lesion as an AV malformation, fistula, or a hemangioma. HAI, TAE and TACE have shown promising symptomatic, morphological and survival results in liver metastases from other primary tumours, like malignant melanoma, neuroendocrine and carcinoid tumours, breast and gastric cancer [22,23,28,29,[33][34][35][36][37][38][39][40][41].…”

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

“…However, few reports are available on HAI therapy for the hepatic metastasis of gastric cancer; one reason for this is that there are fewer patients with gastric cancer in Western countries than in Japan. To our knowledge, only a few retrospective studies and case reports on HAI therapy have been published in Japan [5][6][7][8][9], and no prospective study with a large number of patients has yet been conducted. It has been reported in these studies and case reports that hepatic metastasis of gastric cancer was controlled as easily as that of colorectal cancer.…”