Are there indications for intraarterial hepatic chemotherapy or isolated liver perfusion? The case of liver metastases from colorectal cancer.

Intraarterial hepatic chemotherapy (IAHC) has been used for many years to treat liver tumors (primary or secondary) if no extrahepatic extension exists, when no resection is feasible, and when no active systemic chemotherapy is available. Liver metastases from colorectal cancer represent one of the best indications, and many trials have demonstrated that IAHC is an efficient treatment. Some of these trials were randomized and have demonstrated that IAHC significantly increases the response rate using IA FUDR compared to its systemic administration, and increases the overall survival compared to symptomatic treatment or systemic bolus 5FU. Liver toxicity and extrahepatic progression are the two main limiting factors which can be reduced using new protocols and combinations with systemic chemotherapy. New drugs such as THP adriamycin will become available for IAHC in the future. Isolated liver perfusion adds to IAHC an extracorporal extraction and allows the use of higher doses of chemotherapy. Its efficacy has been suggested in small phase II trials; however, its relative complexity and the lack of clear demonstration of its efficacy compared to the most recent and effective systemic chemotherapies used alone or in combination with IAHC prevent the recommendation of its use outside clinical trials. IAHC and isolated liver perfusion are two active locoregional treatments which can be combined with surgical resection and/or systemic chemotherapy and warrant further development, if possible, in randomized trials.