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Feasibility of Adjuvant Hepatic Arterial Infusion of Chemotherapy After Radiofrequency Ablation With or Without Resection in Patients With Hepatic Metastases From Colorectal Cancer

From the Departments of Surgical Oncology (CLS, SAC, JEG, JNV, MLW, KBG, LME), Gastrointestinal Medical Oncology (YZP), and Diagnostic Radiology (BDF) and the Division of Pharmacy (JLC, RDL), The University of Texas M. D. Anderson Cancer Center, Houston, Texas; and the Department of Surgery (FI, PM, PD, BD, FC), the G. Pascale National Tumor Institute, Naples, Italy.

Correspondence: Address correspondence and reprint requests to: Lee M. Ellis, MD, Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 444, Houston, TX 77030-4009; Fax: 713-792-4689; E-mail: lellis{at}mdanderson.org

Background: The safety of combined hepatic artery infusion chemotherapy (HAI) and radiofrequency ablation (RFA) for liver metastases has not been assessed. We conducted a study to determine the feasibility of using HAI after RFA for colorectal cancer (CRC) liver metastases.

Methods: Between 1996 and 2001, patients with hepatic metastases from CRC were enrolled onto a prospective study of RFA plus HAI consisting of continuous-infusion floxuridine and bolus fluorouracil. Surgical complications, treatment-related toxicities, and patient outcomes were recorded.

Results: Fifty patients were treated with RFA and HAI with or without resection. A median of two lesions per patient, with a median greatest diameter of 2.0 cm, were treated with RFA. Postoperative complications, including 1 death, occurred in 11 of 50 patients. Toxicity from HAI was relatively mild. At 20 months’ median follow-up, 32% of patients remained disease free. Ten percent of patients had recurrences at the site of RFA, 30% developed new liver metastases, and 48% developed extrahepatic disease.

Conclusions: RFA of CRC liver metastases followed by HAI is feasible and is associated with acceptable complication and toxicity rates. The high rate of disease recurrence in our patients indicates that novel combinations of regional and systemic therapies are needed to improve patient outcomes.

Key Words: Radiofrequency ablation • Hepatic artery infusion • Colorectal cancer • Hepatic metastases

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