Treatment of hepatic metastases by percutaneous hepatic arterial infusion.

Better palliation for patients with hepatic metastases requires improved quality and duration of survival with a low complication rate and acceptable expense. Eligible patients between 1967 and 1977 were treated with a program of systemic chemotherapy until progression of hepatic metastases, then hepatic arterial infusion and subsequent maintenance on systemic chemotherapy. The angiography department was able to place the infusion catheter into the common hepatic artery percutaneously in 85% of all patients. The reasons for failure appeared related to anatomic variations and not to the physical characteristics of the liver cancer. A group of 24 patients with colorectal cancer and another group of 28 patients with 13 different primaries were treated. The colorectal cancer patients attained a median treatment time of 8 months before hepatic arterial infusion, and 9 more thereafter. The median survival of 17 months is much better than that reported for systemic chemotherapy alone. In a group of 28 patients with various primaries treated in the same way, the median survival time was 10 months. The nature of complications and the 6% incidence were the same in both groups. In summary, this is a modality yielding improved quality of life and longer survival with a low complication rate and acceptable costs.