Open AccessIntra‐arterial 5‐fluorouracil and intravenous folinic acid in the treatment of liver metastases from colorectal cancer
Author(s) -
Howell J. D.,
Warren H. W.,
Anderson J. H.,
Kerr D. J.,
McArdle C. S.
Publication year - 1999
Publication title -
european journal of surgery
Language(s) - English
Resource type - Journals
eISSN - 1741-9271
pISSN - 1102-4151
DOI - 10.1080/11024159950189708
Subject(s) - medicine , folinic acid , fluorouracil , hepatic arterial infusion , chemotherapy , regimen , colorectal cancer , toxicity , floxuridine , surgery , anesthesia , cancer , gastroenterology
Objective: To compare two regimens of intra‐arterial chemotherapy for the treatment of hepatic metastases from colorectal cancer. Design: Open study. Setting: Teaching hospital, UK Subjects: 57 patients with unresectable metastases confined to the liver, and an indwelling catheter in the hepatic artery. Interventions: The first 33 patients had a 24‐hour intra‐arterial infusion of 5‐fluorouracil (5‐FU) 1500 mg/m 2 , together with folinic acid 200 mg/m 2 intravenously for the first and last two hours of the 5‐FU infusion. This was repeated at weekly intervals for six weeks followed by a two‐week gap before the next cycle. The remaining 24 patients had a two‐weekly regimen in which folinic acid 200 mg/m 2 was infused intravenously over 2 hours followed by an intra‐arterial loading dose of 5‐FU 400 mg/m 2 over 15 minutes; 5‐FU 1600 mg/m 2 was then given by intra‐arterial infusion over 22 hours. This was repeated on day 2 and then at two‐weekly intervals. Main outcome measures: Response rate and toxicity. Results: Median follow‐up was 21 months, and estimated median survival 19 months. 29 patients (51%) have responded, 5 completely. There are no significant differences between the groups. Sites of progression were liver alone 26 (53%), lung alone 9 (18%), liver and lung 3 (6%), and the remainder in local or regional nodes ( n = 7) or bone ( n = 4). Six patients experienced WHO grade 3 or 4 toxicity. Conclusion: The two regimens have high response rates and cause little systemic toxicity. Intra‐arterial chemotherapy for hepatic metastases from colorectal cancer is currently being compared with conventional systemic chemotherapy in a randomised controlled trial. Copyright © 1999 Taylor and Francis Ltd.