CHAPTER 97 - Regional chemotherapy for liver tumors

Abstract

Colorectal cancer represents a significant global health issue, with approximately 150,000 new cases diagnosed annually and an average of 50,000 deaths per year in the United States. The liver is the most common site for metastases, with approximately 60% of patients developing liver metastases throughout the course of their disease, which is a major cause of mortality. The management of liver metastatic colorectal cancer continues to evolve. Oligometastatic colorectal cancer confined to the liver represents an intermediate state in the evolution of metastatic capacity that provides the opportunity for local interventions, such as hepatic arterial infusion (HAI) chemotherapy, which is increasingly being incorporated into the treatment paradigm to improve patient outcomes. HAI chemotherapy with floxuridine, an agent with high first-pass hepatic extraction, limits systemic toxic effects and allows for the administration of systemic chemotherapy at near-full doses. Combination (HAI) and systemic chemotherapy are delivered in cases of colorectal liver metastases with the goal of converting patients to resection, reducing the risk of recurrence after liver resection, treating recurrent disease, and even shows responses in patients with refractory disease, thereby improving survival for this patient population. This chapter outlines the biologic rationale for HAI chemotherapy, the evolution of rational combinations with systemic chemotherapy, contemporary evidence for using HAI and systemic chemotherapy, as well as the morbidity and toxic effect profiles of HAI therapy.