Liver
metastases are a common cause of death in colon
carcinoma. The dual blood supply of the liver permits regional perfusion while hepatic catabolism fo
5-fluorouracil (FU),
floxuridine (
FUdR) permit higher
drug exposures than systemic (IV) administration. We have studied the effect of continuous intra-arterial
chemotherapy (FU: 5-10 mg/kg/day and
FUdR: 0.2 mg/kg/day) and whole liver irradiation (1000 rad every 4 weeks, total dose of 3000 rad) for metastatic colon
carcinoma to liver. Eighteen patients with
metastases to liver only are reported using this combination
therapy. Seven patients had percutaneous placement of a
catheter via the brachial artery, two had operative placement of a
catheter via the gastroduodenal artery, all of which were connected to the Cormed
infusor system, nine had operative placement of the Infusaid implantable pump with
catheter placement into the hepatic artery via the gastroduodenal artery. The median survival for the entire group was 241 days. In those patients whose liver function tests (
bilirubin and
alkaline phosphatase) were less than two times normal, the median survival was 770 days. The median survival of the patients with greater than two times normal LFT's was 178 days. Two patients died of complications of the treatment. One who developed irreversible radiation
hepatitis but at autopsy had only two areas of microscopic
tumor foci in the liver and another who had received only 15 days of infusion and 1000 rad to liver. This patient developed irreversible chemical
enteritis secondary to
chemotherapy infusion into the superior mesenteric artery. Three patients have undergone abdominal reexploration and one at autopsy, who were found to have no gross evidence of
tumor in the liver despite previous pathologic confirmation. It appears that some patients with minimal
tumor burdens can have sterilization of their
tumors. There were three cases of reversible liver function abnormalities. Complications associated with conventional intra-arterial
chemotherapy (artery
thrombosis,
catheter sepsis and dislodgement,
pump infusion variation and pump failure) were not seen with the Infusaid delivery system. The pump is refilled every 2-3 weeks via percutaneous
puncture. All
therapy was given on an outpatient basis. Pump acceptance and tolerance was 100%. Intra-arterial
chemotherapy can now be accomplished without the morbidity associated with it in the past. The combination of
chemotherapy and liver irradiation may offer improved survival in selected patients.