Phase II trial of chemoembolization for the treatment of metastatic colorectal carcinoma to the liver and review of the literature

• Published in: Cancer Vol. 82; no. 7; pp. 1250 - 1259
• Main Authors: Tellez, Claudia, Benson, Al B., Lyster, Michael T., Talamonti, Mark, Shaw, John, Braun, Michael A., Nemcek, Albert A., Vogelzang, Robert L.
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 01.04.1998; Wiley-Liss
• Subjects: angiostat; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Biological and medical sciences; Carcinoembryonic Antigen - analysis; Carcinoma - diagnostic imaging; Carcinoma - mortality; Carcinoma - secondary; Carcinoma - therapy; chemoembolization; Chemoembolization, Therapeutic - adverse effects; cisplatin; Colon and Rectum; colorectal; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); doxorubicin; Feasibility Studies; Humans; liver; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - therapy; Medical sciences; metastatic; mitomycin c; Pharmacology. Drug treatments; Tomography, X-Ray Computed; Treatment Outcome; Antineoplastic agent; Regional treatment; Rectal disease; Carcinoma; Liver; Hepatic disease; Metastasis; Doxorubicin; Phase II trial; Intestinal disease; Colon; Platinum II Complexes; Hepatic artery; Human; Drug combination; Mitomycin; Instrumentation therapy; Malignant tumor; Cisplatin; Colonic disease; Antibiotic; Chemotherapy; Collagen; Rectum; Digestive diseases; Embolization; Anthracyclins; Combined treatment; Bibliographic review
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19980401)82:7<1250::AID-CNCR7>3.0.CO;2-J

BACKGROUND Hepatic artery chemoembolization represents an alternative treatment for patients whose neoplastic lesions are not amenable or have become refractory to other treatment modalities. This project was designed to test the feasibility of regional chemoembolization for patients with colorectal carcinoma metastasis to the liver who had experienced failure with one or more systemic treatments. METHODS Thirty patients who met the study entry criteria underwent one to three hepatic artery chemoembolizations. The chemoembolization regimen consisted of an injection of a bovine collagen material with cisplatin (10 mg/mL), doxorubicin (3 mg/mL), and mitomycin C (3 mg/mL). Repeat treatments were performed at 6‐ to 8‐week intervals. RESULTS Radiologic responses, as measured by a decrease in lesion density of at least 75% of the lesion or a 25% decrease in the size of the lesion, occurred in 63% of the cases. A decrease of at least 25% of the baseline carcinoembryonic antigen level occurred in 95% of the cases. All responses were transient. Median survival for all 30 patients was 8.6 months after the initiation of chemoembolization and 29 months after the initial diagnosis of metastasis to the liver. Common toxicities included a "postembolization syndrome," which consisted of fever > 101 °F (83%), pain in the right upper quadrant (100%), nausea, and vomiting. Lethargy was a common occurrence (in 60+% of cases) and lasted up to 6 weeks. Hematologic toxicities included leukocytosis, anemia, and thrombocytopenia. CONCLUSIONS Chemoembolization is a feasible treatment modality for patients with colorectal carcinoma metastasis to the liver who have experienced failure with other systemic treatments. It results in high response rates with transient mild‐to‐moderate toxicity. Responses are measured in months, however, and all patients have eventual progression of disease. Patients who are able to undergo three or more chemoembolization procedures may receive the most clinical benefit. Cancer 1998;82:1250‐9. © 1998 American Cancer Society. Chemoembolization is a feasible treatment modality for patients with colorectal carcinoma metastasis to the liver for whom systemic treatment has failed. The treatment is well tolerated with transient mild‐to‐moderate toxicity. Responses are generally measured in months. Patients who are able to undergo three or more chemoembolization procedures may receive the most clinical benefit.