Neoadjuvant intra-arterial versus intravenous chemotherapy in colorectal cancer

Abstract

To investigate the clinical benefits of transcatheter arterial infusion chemotherapy compared with intravenous chemotherapy in patients with colorectal cancer (CRC).From May 2013 to March 2018, 83 patients (50 men and 33 women) with surgically proven CRC were retrospectively included. Before surgery, 62 patients received conventional systemic chemotherapy, and 21 transcatheter arterial chemotherapy. Basic characteristics, disease control rate (DC), adverse reactions, postoperative complications, and toxicity profiles were collected and compared between the 2 groups.The sigmoid colon (43.37%) was the most common primary tumor location, and the least was the transverse colon (6.02%). Most lesions invaded the subserosa or other structures T3-4 (78.31%), and other lesions invaded the muscular layer T1-2 (21. 69%). The overall DC was 80.65% in the intravenous chemotherapy group and 90.48% in the arterial chemotherapy group (P < .05). Adverse events included myelosuppression and gastrointestinal reactions such as nausea, vomiting, diarrhea, abnormal liver function, and neurotoxicity, which were significantly less common in the intra-arterial group than in the intravenous group (P < .05). Postoperative complications included abdominal infection (11.29% vs 14.29%), intestinal obstruction (6.45% vs 4.76%), anastomotic bleeding (1.61% vs 0.00%), and anastomotic fistula (6.45% vs 4.76%) in the intravenous and intra-arterial groups, respectively (P > .05).Preoperative transcatheter arterial infusion chemotherapy is a safe and effective neoadjuvant chemotherapy measure for CRC with fewer adverse reactions and a higher overall DC.

Figure 1

Colorectal cancer. Selected axial images of a contrast-enhanced (CT) scan of the abdomen demonstrate isodense mass on the rectum at (A, B) baseline (before chemotherapy) and (C, D) follow-up after chemotherapy. A digital subtraction arteriogram via IMA, contrast injection reveals thick, highly tortuous tumor vasculature and obvious contrast staining on the tumor (E) (first chemotherapy) compared to (F) follow- up second chemotherapy.

Figure 2

Colorectal cancer. Selected axial images of a contrast-enhanced (CT) scan of the abdomen demonstrate an isodense mass on the colon at (A, B) baseline (before chemotherapy) and (C, D) follow-up after chemotherapy. A digital subtraction arteriogram via IMA, contrast injection reveals a thick, highly tortuous tumor vasculature and obvious contrast staining on the tumor (E) (first chemotherapy) compared to (F) follow-up to second chemotherapy. This lesion decreased in size in its long-axis diameter resulting in a partial response.

Figure 3

Colorectal cancer. Selected axial (A–D) and sagittal (E) MRI images demonstrate a mass on the colon at (A–E) baseline (before chemotherapy) and (F–J) follow-up after chemotherapy. A digital subtraction arteriogram via IMA, contrast injection reveals a thick, highly tortuous tumor vasculature and obvious contrast staining on the tumor (K) (first chemotherapy) compared to (L) follow-up second chemotherapy. This colorectal carcinoma decreased its size in its long-axis diameter resulting in a partial response.

Figure 4

Colorectal cancer. Selected axial (A, B) and sagittal (C) MRI images demonstrate mass on colon at (A–C) baseline (before chemotherapy) and (D–F) follow-up after chemotherapy. A digital subtraction arteriogram via IMA, contrast injection reveals a thick, tortuous tumor vasculature and obvious contrast staining on the tumor (G). This colorectal carcinoma decreased its size in its long-axis diameter resulting in a partial response.

Figure 5

Colorectal cancer. Selected axial images of a contrast-enhanced (CT) scan of the abdomen demonstrate isodense mass on sigmoid colon at (A) baseline (before chemotherapy) and (B) follow-up after chemotherapy. A digital subtraction arteriogram via IMA, contrast injection reveals a thick, highly tortuous tumor vasculature and obvious contrast staining on the tumor (C) (first chemotherapy) compared to (D) follow-up second chemotherapy. This colorectal carcinoma decreased its size in its long-axis diameter resulting in a partial response.