Intraarterial chemotherapy in treatment of unresectable colorectal liver metastases refractory to systemic chemotherapy

Aim. To estimate the effectiveness of intraarterial chemotherapy in treatment of patients with unresectable colorectal liver metastases resistant to systemic chemotherapy.
Materials and methods. Between 2011 and 2018, 64 patients were treated. Previously performed 3–35 cycles of systemic chemotherapy was assessed as ineffective in 58 and discontinued in 6 patients because of grade III–IV toxicity. The most effective cytostatics previously used in systemic chemotherapy was used for intraarterial therapy. In the absence of effective drugs, monotherapy with Mitomycin C was done. For hypovascular metastases hepatic arterial infusion was performed using 4–6 g 5-fluorouracil, 15–20 mg Mitomycin C, 150–200 mg Oxaliplatin or 160–200 mg Irinotecan per cycle. For hypervascular metastases was used oily chemoembolization included selective infusion of suspension consisted of Lipiodol with Mitomycin C 10–20 mg or Irinotecan 160–200 mg or Doxorubicin 50–80 mg followed by occlusion of feeding arteries with gelfoam. Combination TACE + HAI was performed in anatomical variants of hepatic artery.
Results. We performed 238 cycles of intraarterial chemotherapy (from 2 to 16, average 3,7 per patient). There were no major complications and mortality. Progression-free survival after the intraarterial chemotherapy was 11.7 months. The median survival from the start of first cycle of systemic chemotherapy was 22 mo. in group patients with synchronous and 23 mo. with metachronous metastases.
Conclusion. Preliminary results show promising intraarterial chemotherapy for treatment of patients with chemoresistant colorectal liver metastases. The application of the method makes it possible to reduced tumor growth for one year after interruption of systemic chemotherapy.

liver, colorectal cancer metastases, intraarterial chemotherapy, chemoembolization, chemoresistance

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