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21 - Clinical Management of Patients with Colorectal Liver Metastasis Using Hepatic Arterial Infusion

from PART III - ORGAN-SPECIFIC CANCERS

Published online by Cambridge University Press:  18 May 2010

By
Fidel David Huitzil Melendez  and
Nancy Kemeny
Edited by
Jean-François H. Geschwind  and
Michael C. Soulen
Fidel David Huitzil Melendez
Affiliation:
Gastrointestinal Oncology Fellow Memorial Sloan-Kettering Cancer Center, New York, NY
Nancy Kemeny
Affiliation:
Attending Physician Memorial Sloan-Kettering Cancer Center Professor of Medicine, Weill Medical College of Cornell University New York, NY
Jean-François H. Geschwind
Affiliation:
The Johns Hopkins University School of Medicine
Michael C. Soulen
Affiliation:
University of Pennsylvania School of Medicine
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Summary

Liver metastases from colorectal cancer is a suitable clinical model for regional drug delivery for several reasons: as a result of portal venous drainage, the liver can be the first and only site of metastatic disease in patients with colorectal cancer (1). This is in contrast with other gastrointestinal malignancies, in which liver metastases are frequently a marker of widespread disease, as is the case of gastric cancer and pancreatic cancer (2). In addition, colon cancer has favorable tumor biology compared with other gastrointestinal or non-gastrointestinal malignancies. When liver resections were performed under the same criteria for liver metastases from colon cancer and from gastric cancer, 5-year overall survival was 30% for colon cancer patients and 0% for gastric cancer patients (3). Furthermore, the hepatic artery (HA) is the main blood supply of liver metastases (4). Totally implantable infusion systems have been developed (5), and the surgical techniques have improved (5), allowing a higher percentage of patients to receive regional treatment for longer periods of time.

Identification of ideal candidates is critical for optimal clinical results. Selection criteria focus on identifying patients with liver-only metastatic disease, with suitable hepatic arterial anatomy for pump placement. For this purpose, work-up should include computed tomography scan of the chest, abdomen and pelvis with liver angiography. Positron emission tomographic scans are not routinely performed, but they can be helpful in determining the nature of enlarged periportal lymph nodes or other indeterminate lesions (6).

Type
Chapter
Information
Interventional Oncology
Principles and Practice
 , pp. 249 - 263
Publisher: Cambridge University Press
Print publication year: 2008

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