[Adjuvant regional chemotherapy after resection of liver metastases of primary colorectal tumors].

Due to the pattern of tumor infiltration, hepatic resection may be accomplished in 20% of all patients with colorectal liver metastases. However, a new recurrence is observed very often and early. Up to date, systemic adjuvant treatment failed to improve the overall results. Taking into account the benefit of palliative intrahepatic chemotherapy, intraarterial therapy was performed as an adjuvant to removal of metastatic colorectal liver metastases in 51 out of 90 patients over an eight year period (1982-90). Due to abnormal arterial liver arteries 5 pat. got an intraportal catheter. The following monthly treatment schedules were applied: FUDR (fluorodesoxyuridine) 0.2-0.3 mg/kg/d/14 d (N = 12), FUDR 1,2 mg/kg/d/5d (N = 21), FUDR 1.0-1.7 mg/kg/d/5 and folinic acid 30 mg/m2/d (N = 18). Mortality (5.5%) and morbidity (36%) were not increased by catheter implantation. Local and systemic side effects were mainly stomatitis 0-22% and hepatobiliary toxicity 6-42%. Including an operative mortality of 5.5%, the median survival of 45 months was associated with a disease-free interval of 15 months. Intrahepatic recurrence was diagnosed after a median time of 26 months (extrahepatic recurrence was 25 months respectively). The following prognostic factors were associated with favourable survival: solitary metastasis (p > 0.001), curative resection, segmentectomy, normal serum levels of CA 19-9 and LDH. Although both groups were not comparable, due to more extended tumor infiltration in the treatment group (p = 0.03), adjuvant arterial chemotherapy delayed after curative resection intrahepatic recurrence to 52 versus 14 months (p = 0.036). Disease-free survival was improved to 19 versus 12 months (p = 0.08) resulting in a trend to better overall survival (p = 0.07).