Second-look hepatectomy after pharmacokinetic modulating chemotherapy (PMC) combination with hepatic arterial 5FU infusion and oral UFT in patients with unresectable hepatic colorectal metastases

Abstract

3739 Background:In order to improve prognosis we carried out hepatectomy on patients with initially unresectable hepatic metastases, where the metastic lesions had shrunk and resection subsequently became possible (second-look hepatectomy: s-l hepatectomy) after neoadjuvant chemotherapy by HAI plus the oral anticancer drug UFT (pharmacokinetic modulating chemotherapy by HAI: HAI-PMC). Methods:Since 1993, 51 patients with unresectable hepatic metastases for colorectal carcinoma without extra hepatic diseases received HAI-PMC. The regimen of HAI-PMC is a combination of intra-arterial infusion of 5FU for 2 consecutive days per week at 600mg/m2/day and oral administration of UFT at 400 mg/day for 5 days per week for 6 months. Results:The response rate to HAI-PMC was 78.4%, but 6 months after starting HAI-PMC we judged thirty-one of the 51 patients(61%) to be cases where s-l hepatectomy was possible. Twenty-four of the 31 patients agreed to undergo s-l hepatectomy (A group) while 8 patients chose to go on HAI-PMC (B group). The two-year, three-year and five-year survival rates of patients in the A group were 84%, 58% and 42%, and for those in the B group, 62%, 25% and 0%. The survival rate of patients in the A group was significantly higher than for those the B group.(P=0.039) (median follow-up period, 42 months) Conclusions:These results indicate that there is no hope of a cure by chemotherapy for unresectable hepatic metastases, but that there is the possibility of a cure with s-l hepatectomy after HAI-PMC. No significant financial relationships to disclose.