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Annals of Surgical Oncology 9:148-155 (2002)
© 2002 Society of Surgical Oncology

ORIGINAL ARTICLES

Systemic Irinotecan and Regional Floxuridine After Hepatic Cytoreduction in 185 Patients With Unresectable Colorectal Cancer Metastases

David A. Litvak, MD, Thomas F. Wood, MD, George J. Tsioulias, MD, DMSc, Mathew Chung, MD, Sant P. Chawla, MD, Leland J. Foshag, MD, Donald L. Morton, MD, Kenneth P. Ramming, MD and Anton J. Bilchik, MD, PhD

From the Division of Surgical Oncology (DAL, TFW, GJT, MC, LJF, DLM, AJB), John Wayne Cancer Institute, Saint John’s Health Center, Santa Monica, California; and Century City Hospital (SPC, LJF, KPR, AJB), Los Angeles, California.

Correspondence: Address correspondence and reprint requests to: Anton J. Bilchik, MD, PhD, 2200 Santa Monica Blvd., Santa Monica, CA 90404; Fax: 310-449-5261; E-mail: bilchika{at}jwci.org

Background: This study evaluated our 7-year experience treating unresectable colorectal cancer (CRC) hepatic metastases refractory to systemic 5-fluorouracil.

Methods: A total of 185 patients with unresectable 5-fluorouracil-resistant CRC hepatic metastases underwent surgical cytoreduction. Postoperatively patients received either hepatic arterial floxuridine (FUDR) and systemic irinotecan as part of a phase II trial or no further treatment.

Results: Of the 185 patients undergoing surgical cytoreduction, 71 patients received adjuvant irinotecan/FUDR. There were no appreciable differences in synchronous or metachronous lesions or the median number or size of lesions between treatment groups. At a median follow-up of 20 months, there were fewer recurrences in patients treated with postoperative irinotecan/FUDR compared with untreated patients for both hepatic and extrahepatic recurrences. Progression-free and overall survival were longer for patients who received irinotecan/FUDR compared with patients who did not receive adjuvant therapy. The 2-year survival rate was significantly better for patients receiving adjuvant therapy compared with patients receiving no additional treatment. Predictors of improved survival included a preoperative carcinoembryonic antigen level <100 ng/dl, >30% postoperative reduction in carcinoembryonic antigen level, and adjuvant therapy.

Conclusions: Combined therapy with irinotecan/FUDR may improve the results of surgical cytoreduction for unresectable CRC hepatic metastases.

Key Words: Cytoreductive surgery • Cryosurgical ablation • Irinotecan • Floxuridine • Metastatic colorectal cancer • Regional chemotherapy




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