REGIONAL CHEMOTHERAPY IN TREATMENT FOR UNRESECTABLE COLORECTAL CANCER METASTASES TO THE LIVER RESISTANT TO SYSTEMIC CHEMOTHERAPY

Abstract

Aim. To determine the effectiveness of regional chemotherapy (RChT) in the treatment of patients with unresectable colorectal metastases to the liver, resistant to systemic chemotherapy (SChT). Materials and methods. Between 2011 and 2017, we treated 60 patients with unresectable colorectal metastases to the liver, resistant to SChT from 2011 to 2017 y. All patients received previously 3-35 cycles of SCht which were ineffective in 54 and was discontinued in 6 patients because of grade III-IV toxicity. In all patients, antitumor drugs which were most effective in SChT were used for RChT,. In the absence of effect on any schemes of SChT, monotherapy with the Mitomycinum C was done. Hepatic arterial infusion (HAI) was carried out for hypovascular metastases using 4-6 gr 5-fluorouracil, 15-20 mg mitomycinum C, 150-200 mg oxaliplatinum, 160200 mg irinotecan. Transcatheter arterial chemoembolization (TACE) for hypervascular metastases was performed by selective infusion of suspension of Lipidol with chemotherapeutic drug: mitomycin C 10-20 mg or irinotecan 160-200 mg or doxorubicinum 50-80 mg and followed by arterial occlusion by gelfoam. Combination, TACE+HAI, was performed with difficult anatomical variants of hepatic artery. Results. We performed 222 cycles of RChT (from 2 to 15, average 6 per patient). There were no complication and lethality. Time to progression after the onset of RChT was 12.4 months in both groups. The median survival from the start of the first cycle SChT was 22 mo in the group with synchronous metastases of colorectal cancer to the liver and 23 mon for metachronic group. Conclusion. Our preliminary results showed prospect of using RChT in the treatment of patients with chemo-resistant colorectal metastases to the liver.