Utility of embolization or chemoembolization as second‐line treatment in patients with advanced or recurrent colorectal carcinoma

• Published in: Cancer Vol. 74; no. 6; pp. 1706 - 1712
• Main Authors: Martinelli, Donald J., Wadler, Scott, Bakal, Curtis W., Cynamon, Jacob, Rozenblit, Alla, Haynes, Hilda, Kaleya, Ronald, Wiernik, Peter H.
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 15.09.1994; Wiley-Liss
• Subjects: 5‐fluorouracil; Adult; Aged; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Chemoembolization, Therapeutic - adverse effects; Chemoembolization, Therapeutic - methods; chemotherapy; colorectal cancer; Colorectal Neoplasms - mortality; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Drug Combinations; embolization; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Female; Fluorouracil - administration & dosage; Humans; interferon; Interferon-alpha - administration & dosage; Liver Abscess - drug therapy; Liver Abscess - etiology; Liver Neoplasms - drug therapy; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - therapy; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Treatment Outcome; Antineoplastic agent; Hepatic artery; Adenocarcinoma; Human; Rectal disease; Liver; Instrumentation therapy; Hepatic disease; Malignant tumor; Metastasis; Colonic disease; Chemotherapy; Rectum; Digestive diseases; Intestinal disease; Embolization; Advanced stage; Combined treatment; Intraarterial administration; Colon
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(19940915)74:6<1706::AID-CNCR2820740611>3.0.CO;2-J

Background. Second‐line therapy of patients with colorectal cancer metastatic to the liver is unsatisfactory. One alternative to systemic treatment is therapy directed locoregionally. Methods. Twenty‐four patients with unresectable colorectal cancer with bulky liver metastases who had failed prior systemic therapy were randomized to treatment with either embolization or chemoembolization. For the embolization group, particulate transcatheter polyvinyl alcohol (PVA) (150‐250‐μm particles) mixed with full‐strength iodinated radiographic contrast was administered under direct fluoroscopic control. In patients randomized to chemoembolization, 5‐fluorouracil (750 mg/m2) and recombinant alpha‐2a‐interferon (Roche Laboratories, Nutley, NJ) (9‐MU) were thoroughly mixed into the PVA contrast suspension. Study end points were response to therapy and survival. Results. Of 24 patients, 13 were randomized to chemoembolization and 11 to embolization therapy. All were assessable for toxicity, response, and complications. Among the first 13 patients treated initially, a suppurative abscess developed in one patient, who died. Eleven subsequent patients were pretreated with oral and intravenous antibiotics without further infectious complications. Five patients had hemorrhagic complications, two of which were serious. The treatment was otherwise well tolerated, with most patients experiencing transient pain, fevers, and elevations in leukocyte counts and liver enzymes, which resolved spontaneously. Computed tomography scans of the liver were used to assess patient response to therapy. There were 6 responders (25%) among the 24 patients treated. No differences in response to treatment or survival between the embolization and chemoembolization groups were noted. With a median follow‐up of more than 12 months, the median survival was 9.3 months from the time of embolization therapy. Conclusions. Embolization and chemoembolization therapy appear to have antitumor activity as second‐line therapy in patients with colorectal carcinoma with bulky liver metastases. Although generally well tolerated, complications of this therapy may be severe. The addition of further patients to this trial will allow a rigorous comparison of embolization alone versus embolization with chemotherapy.