[The role of prophylactic hepatic arterial infusion chemotherapy after potentially curative resection of hepatic metastases from colorectal cancer]

Abstract

Although hepatic arterial infusion (HAI) chemotherapy using fluoropyrimidines is pharmacologically regarded as an ideal therapy for colorectal liver metastases, clinical evaluation of prophylactic HAI following curative hepatectomy has not been carried out. In this report, we review the published literature on this treatment and discuss its efficacy and adverse effects. Fluorodeoxyuridine (FUDR) or 5-fluorouracil (5-FU) was used as the agent and a total dosage of 10-20 g was administered for 6-12 months in most studies. Despite adjuvant therapy, complications including hepatitis, cholangitis, peptic ulcer, and obstruction of the hepatic artery are often reported. Cessation of therapy was also necessary in some studies because of adverse effects or technical problems. In terms of therapeutic effect, significantly higher disease-free survival was achieved in most studies. However, it is still controversial whether this treatment has an ultimate survival benefit. Thus reasonable protocols that do not impair patients' quality of life should be adopted for prophylactic HAI. Furthermore, it is desirable to develop a new regimen combining HAI with systemic chemotherapy to achieve improved survival rates.