Therapy For Liver Metastases Research Articles

Regional infusion chemotherapy for colorectal hepatic metastases—where is it going?

Colorectal cancer is the second most frequent cause of cancer death in the U.K. responsible for 22,000 deaths per annum. The incidence of hepatic metastases in those relapsing after 'curative ' surgery is at least 50°,~, and there is clearly a need tbr more effective treatment. Interest in regional inliasion chemotherapy arose because of the failure of systemic therapy to influence the course of the disease. Regional infusion chemotherapy to the liver was first at tempted over 30 years ago. Initially, t reatment was carried out using percutaneously placed angiographic catheters. However, this was associated with cracked and blocked catheters as well as gastroduodenal and hepatic toxicity. However, since 1980, interest has been rekindled due to the development of the implantable pump. The accuracy and reliability of these pumps means that patients can now receive continuous treatment as an outpatient without interfering with daily activities. The main limitations of the system are the requirement for low volume chemotherapy in a stable solution, the cost of the pump and its implantation. The requirements for regional infusion therapy for liver metastases are:

Fotemustine (S 10036) in the Intra-Arterial Treatment of Liver Metastasis from Malignant Melanoma

Fotemustine is a new nitrosourea which has shown some efficacy on disseminated malignant melanoma (DMM) (24.2% response rate (RR) among 153 patients in a Phase II trial) but little activity on hepatic metastasis (8.8% RR). In order to improve those poor results, hepatic intra-arterial infusion (HIAI) of fotemustine was performed. After two years, thirteen patients, all in good general condition, were evaluable. Seven were pretreated and six had extrahepatic metastasis on entry into the study. All patients had a surgically implanted intra-arterial catheter. The induction cycle consisted of 100 mg/m2/week for 3-4 weeks, followed by 5 weeks rest and maintenance therapy of 100 mg/m2 every 3 weeks for stabilized or responding patients. Two complete responses (CR) (72+ and 145+ weeks) and six partial responses (PR) (7-18.5 weeks) were observed. The hepatic RR reached 61.5%. A RR of 42.8% was registered on preexisting EHM (one CR and one PR on cerebral lesions). Nevertheless, this treatment is limited by the high progression rate of 46.1% in extrahepatic disease. Toxicity was mainly hematologic (grade III-IV), comprising 36% neutropenia and 15% thrombopenia. Hepatic intra-arterial infusion of fotemustine is efficient therapy for liver metastases of DMM, but combination schedules (IV + HIA) are warranted.

LEIOMYOSARCOMA OF THE ALIMENTARY TRACT -REPORT OF FOUR CASES AND ANALYSIS OF PROGNOSTIC FACTORS-

Leiomyosarcoma of the alimentary tract is rare, but recently there have been some cases reported in Japan. We report four surgically treated cases of liomyosarcoma of the alimentary tract: two cases were leiomyosarcoma of the jejunum and the others were leiomyosarcoma of the rectum. Liver metastases were found in two of the four cases. One patient with leiomyosarcoma of the rectum metastatic to the liver, who underwert right hepatic lobectomy, survived for about seven years after local excision. The other patient with liver metastasis, who was given postopertive chemotherapy, died twenty-two months after partial enterectomy. No lymph node metastasis was found in any of these cases.It was disclosed that operative curability, early diagnosis and therapy for liver metastasis were the prognostic factors of leiomyosarcoma.