Abstract
This paper presents an experience of thirty consecutive patients with hepatic colorectal metastases who were treated with hepatic cryotherapy and subsequent hepatic arterial infusion (HAI) chemotherapy using 5FU. Patients with colorectal metastases confined to the liver but not suitable for resection, and with liver involvement of less than 50% were offered the treatment. Prospective documentation of all patients was undertaken with data being recorded on a computerised database. Patients had a median of 6 (2–15) lesions with sizes ranging from 1–12 cm. There was no 30 day mortality. Postoperative complications developed in 8 patients but were followed by full recovery in all instances. Side effects from chemotherapy occured in 23% of cycles. Twenty seven patients have died. Median survival from the time of cryotherapy was 18.2 months (7–34), or 23months (9–44) from diagnosis of liver lesions. Hepatic cryotherapy with subsequent arterial chemotherapy is safe and well tolerated. The results suggest survival of patients with colorectal hepatic metastases can be improved by the use of this modality of treatment.
Highlights
Colorectal cancer is a common disease in New Zealand with approximately 2000 new cases being registered annually
In contradistinction to most types of liver metastases those from colorectal cancer can occur without tumour growth elsewhere [1, 21, 22]
There is reason to believe it should be more widely considered for patients with metastatic colorectal cancer in the liver [17]
Summary
Colorectal cancer is a common disease in New Zealand with approximately 2000 new cases being registered annually. Liver metastases are found at diagnosis in some 25% of patients with colorectal cancer [1] and another 25-40% will eventually develop metastases [2]. Median survival for patients with untreated colorectal hepatic metastases is 6 to 8 months from diagnosis, and less than 2% survive for 5 years [3]. Surgical resection of liver metastases confers a median survival of over two years and a 2552% five-year survival rate [4,5,6]. Because of the number and/or location of metastases within the liver, fewer than 25% of patients are candidates for resection [7]. It spares more normal liver tissue than resection, allowing multiple lesions affecting both lobes of the liver to be treated
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