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Abstract
The outlook for patients with colorectal liver metastases is poor. Microspheres have been combined with cytotoxics and administered via the hepatic artery in an attempt to improve tumour drug exposure within the liver. However, it has been suggested that arteriovenous connections might occur in association with intrahepatic tumours causing loss of regional advantage, and that the administration of microspheres further exacerbates arteriovenous shunting. In seven patients with colorectal liver metastases, base-line shunting was measured using a tracer quantity of radio-labelled albumin microspheres. The shunted fraction of a 'therapeutic quantity' of microspheres was subsequently measured in the same group of patients using albumin microspheres carrying a different radio-label. Base-line shunt for 0.5 x 10(6) microspheres was found to be 2.2 +/- 1.8% (mean +/- s.d.); the percentage shunt of a therapeutic quantity (40-80 x 10(6)) of microspheres was 3.0 +/- 0.8%. We conclude that arteriovenous shunting in patients with colorectal liver metastases is minimal, and is not significantly increased by the administration of therapeutic quantity of microspheres during regional chemotherapy.
Highlights
The aim of this study is to establish the level of base-line shunting and the effect of a therapeutic quantity of microspheres on shunting
"3'I-labelled albumin microspheres were made in the following way
High levels of base-line shunting have been reported in patients with metastatic liver disease, and much higher levels have been reported when large numbers of biodegradable microspheres are co-administered with chemotherapy (Starkhammar et al, 1987; Ensminger et al, 1985)
Summary
The aim of this study is to establish the level of base-line shunting and the effect of a therapeutic quantity of microspheres on shunting
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