Repeated transarterial chemoembolisation using different chemotherapeutic drug combinations followed by MR-guided laser-induced thermotherapy in patients with liver metastases of colorectal carcinoma

Abstract

Background: To evaluate a treatment protocol with repeated transarterial-chemoembolisation (TACE) downsizing before MR-guided laser-induced interstitial thermotherapy (LITT) using different chemotherapeutic combinations in patients with unresectable colorectal cancer (CRC) liver metastases.

Methods: Two hundred and twenty-four patients were included in the current study. Transarterial-chemoembolisation (mean 3.4 sessions per patient) was performed as a downsizing treatment to meet the LITT requirements (number5, diameter <5 cm). The intra-arterial protocol consisted of either Irinotecan and Mitomycin (n=77), Gemcitabine and Mitomycin (n=49) or Mitomycin alone (n=98) in addition to Lipiodol and Embocept in all patients. Post TACE, all patients underwent LITT (mean 2.2 sessions per patient).

Results: Overall, TACE resulted in a mean reduction in diameter of the target lesions of 21.4%. The median time to progression was 8 months, calculated from the start of therapy and the median local tumour control rate was 7.5 months, calculated as of therapy completion. Median survival of patients calculated from the beginning of TACE was 23 months (range 4-110 months), in patients treated with Irinotecan and Mitomycin the median was 22.5 months, Gemcitabine and Mitomycin 23 months and Mitomycin only 24 months with a statistically significant difference between the groups (P<0.01).

Conclusion: Repeated TACE offers adequate downsizing of CRC liver metastases to allow further treatment with LITT. The combined treatment illustrates substantial survival rates and high local tumour control with statistically significant differences between the three protocols used. Further randomised trials addressing the current study results are required.

Figure 1

Bar graph showing the mean diameters of the lesions after TACE (light grey) compared with the mean diameters before TACE (dark grey). For each patient group, the obtained data is represented as two columns grouped together. The groups of columns are ordered from left to right as follows: results of all metastases, results of those treated by Mitomycin, results of those treated by Mitomycin-Gemcitabine and results of those treated by Mitomycin-Irinotecan.

Figure 2

Box plot illustrating the median local tumour control in months with 25 and 75% quartiles calculated from last LITT treatment. The columns are ordered from left to right as follows: results of all metastases, results of those treated by Mitomycin, results of those treated by Mitomycin-Gemcitabine and results of those treated by Mitomycin-Irinotecan.

Figure 3

Kaplan–Meier survival curves demonstrating the survival of the patients divided in three groups by virtue of the chemotherapeutic drug used: Group 1 received Mitomycin (n=98, median survival 24 months). Group 2 treated with a Mitomycin-Gemcitabine combination (n=49, median survival 23 months). Group 3 treated with a Mitomycin-Irinotecan combination (n=77, median survival 22.5 months). Log-rank test results showed a statistically significant difference between the three groups of patients (P<0.01).