Abstract
Colorectal cancer is the third most common malignancy in the United States, with about 150,000 newly diagnosed cases per year.1 About half of all patients ultimately develop liver metastases and in 50% of those liver involvement is the dominant clinical problem.2,~ Resection of hepatic metastases is only feasible in about 10% of patients and systemic chemotherapy produces responses in 15 to 35% of patients. Hepatic intra-arterial (HIA) chemotherapy has been used to treat patients with metastatic colorectal carcinoma confined to the liver since the early 1960s.s The theoretical advantage of this route of drug delivery is its ability to enhance anti-tumor effect by increasing drug exposure at the tumor site and to minimize toxicity by decreasing systemic drug exposure. The availability of the totally implantable pump in the early 1980s greatly facilitated prolonged outpatient administration of HIA chemotherapy. Numerous phase II and III trials have documented the activity of this therapy.9-19 In order to safely and effectively deliver HIA chemotherapy, complete hepatic perfusion and the absence of gastrointestinal misperfusion must be achieved. This requires both proper catheter placement and surgical division of all vessels that supply the distal stomach and duodenum which arise from the hepatic artery distal to the point of cannulation.20 Intra-operatively, fluorescein injection into the pump sidepores with inspection of the liver and gastroduodenum using a Wood's lamp is done to assure proper catheter placement. A post-operative, hepatic perfusion study (comparing an intra-arterial technetium-99m macroaggregated albumin scan to an intravenous technetium-99m sulfur colloid scan)20 has been routinely used to further verify the perfusion pattern. Hepatic artery infusion computerized tomography can also be
Published Version
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