ABSTRACT
One-third of patients with colorectal cancer will be diagnosed with hepatic involvement during the course of their disease. In many of them, it will be the only site of metastatic spread. The degree of hepatic involvement is known to be a prognostic factor. In a retrospective study by Wood et al,1 the 1year survival rate was 60% in the presence of solitary liver lesions, and dropped to 5.7% in the presence of widespread hepatic disease. The primary treatment for liver metastases is surgery.2,3 The 3-year survival rate is over 40%, and in series with long follow-up, the 10-year survival rate approximates 20%.4-8 While surgical resection remains the standard of care in the treatment of isolated metastatic disease to the liver from colorectal cancer, over 90% of patients will be ineligible for resection. For these patients, systemic chemotherapy with 5-fluorouracil (5-FU) and leucovorin (LV) has been the standard treatment, with 2year survival rates of less than 20%. Although better responses may be seen with newer agents such as oxaliplatin or irinotecan (CPT-11) in combination with 5-FU and LV, the majority of patients treated with systemic chemotherapy are not alive at 2 years. Given this poor response to standard chemotherapy, alternative options for locoregional control have been investigated. The most promising of these options is hepatic arterial infusion (HAI).
