Adjuvant Hepatic Arterial Chemotherapy Following Metastasectomy in Patients with Isolated Liver Metastases

Mark Onaitis, Michael Morse, Herbert Hurwitz, Peggy Cotton, Douglas Tyler, Pierre Clavien, Bryan Clary, Leslie H. Blumgart, Kelly M. McMasters, William C. Chapman, John M. Daly, Mark W. Onaitis

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objective: To examine survival and toxicity by querying a single-institutional experience with adjuvant hepatic arterial infusional (HAI) chemotherapy. Summary: Background Data Three randomized series in the literature have examined adjuvant HAI after complete resection of liver metastases. Only one of these trials showed an overall survival benefit at 2 years but not over the entire time period of the study. Previous studies in patients with unresectable disease were plagued by high rates of biliary toxicity. Methods: A retrospective review of a prospectively maintained database was performed. Hepatic arterial pumps were placed in the standard fashion. Patients received floxuridine at doses previously demonstrated as safe in the literature. Standard statistical methods were used. Results: Twenty-one of 92 patients underwent placement of hepatic arterial pumps at the time of liver resection. The HAI group was similar in all demographic measures to the non-HAI group, with the exception that the HAI patients were significantly younger. No differences were seen between the groups in either disease-free or overall survival, although a trend toward improved hepatic progression-free survival was noted. Significant biliary sclerosis developed in six patients in the HAI group, requiring chronic indwelling stents in four patients. One patient died of progressive liver failure associated with this toxicity. Conclusions: Biliary toxicity is an important potential side effect of hepatic arterial chemotherapy. Although larger randomized studies and this one suggest significant improvements in hepatic recurrences, these have not reliably translated into overall survival benefit. This fact, in light of the potential toxicity, would argue for a larger confirmatory trial of HAI in the adjuvant setting, incorporating recent advances in systemic therapy and careful attention to hepatotoxicity.

Original languageEnglish (US)
Pages (from-to)782-789
Number of pages8
JournalAnnals of Surgery
Volume237
Issue number6
DOIs
StatePublished - Jan 1 2003
Externally publishedYes

Fingerprint

Metastasectomy
Neoplasm Metastasis
Drug Therapy
Liver
Survival
Floxuridine
Liver Failure
Sclerosis

ASJC Scopus subject areas

  • Surgery

Cite this

Adjuvant Hepatic Arterial Chemotherapy Following Metastasectomy in Patients with Isolated Liver Metastases. / Onaitis, Mark; Morse, Michael; Hurwitz, Herbert; Cotton, Peggy; Tyler, Douglas; Clavien, Pierre; Clary, Bryan; Blumgart, Leslie H.; McMasters, Kelly M.; Chapman, William C.; Daly, John M.; Onaitis, Mark W.

In: Annals of Surgery, Vol. 237, No. 6, 01.01.2003, p. 782-789.

Research output: Contribution to journalArticle

Onaitis, M, Morse, M, Hurwitz, H, Cotton, P, Tyler, D, Clavien, P, Clary, B, Blumgart, LH, McMasters, KM, Chapman, WC, Daly, JM & Onaitis, MW 2003, 'Adjuvant Hepatic Arterial Chemotherapy Following Metastasectomy in Patients with Isolated Liver Metastases', Annals of Surgery, vol. 237, no. 6, pp. 782-789. https://doi.org/10.1097/01.SLA.0000071561.76384.19
Onaitis, Mark ; Morse, Michael ; Hurwitz, Herbert ; Cotton, Peggy ; Tyler, Douglas ; Clavien, Pierre ; Clary, Bryan ; Blumgart, Leslie H. ; McMasters, Kelly M. ; Chapman, William C. ; Daly, John M. ; Onaitis, Mark W. / Adjuvant Hepatic Arterial Chemotherapy Following Metastasectomy in Patients with Isolated Liver Metastases. In: Annals of Surgery. 2003 ; Vol. 237, No. 6. pp. 782-789.
@article{209adecc2f8446f9bd72042521dfd2c9,
title = "Adjuvant Hepatic Arterial Chemotherapy Following Metastasectomy in Patients with Isolated Liver Metastases",
abstract = "Objective: To examine survival and toxicity by querying a single-institutional experience with adjuvant hepatic arterial infusional (HAI) chemotherapy. Summary: Background Data Three randomized series in the literature have examined adjuvant HAI after complete resection of liver metastases. Only one of these trials showed an overall survival benefit at 2 years but not over the entire time period of the study. Previous studies in patients with unresectable disease were plagued by high rates of biliary toxicity. Methods: A retrospective review of a prospectively maintained database was performed. Hepatic arterial pumps were placed in the standard fashion. Patients received floxuridine at doses previously demonstrated as safe in the literature. Standard statistical methods were used. Results: Twenty-one of 92 patients underwent placement of hepatic arterial pumps at the time of liver resection. The HAI group was similar in all demographic measures to the non-HAI group, with the exception that the HAI patients were significantly younger. No differences were seen between the groups in either disease-free or overall survival, although a trend toward improved hepatic progression-free survival was noted. Significant biliary sclerosis developed in six patients in the HAI group, requiring chronic indwelling stents in four patients. One patient died of progressive liver failure associated with this toxicity. Conclusions: Biliary toxicity is an important potential side effect of hepatic arterial chemotherapy. Although larger randomized studies and this one suggest significant improvements in hepatic recurrences, these have not reliably translated into overall survival benefit. This fact, in light of the potential toxicity, would argue for a larger confirmatory trial of HAI in the adjuvant setting, incorporating recent advances in systemic therapy and careful attention to hepatotoxicity.",
author = "Mark Onaitis and Michael Morse and Herbert Hurwitz and Peggy Cotton and Douglas Tyler and Pierre Clavien and Bryan Clary and Blumgart, {Leslie H.} and McMasters, {Kelly M.} and Chapman, {William C.} and Daly, {John M.} and Onaitis, {Mark W.}",
year = "2003",
month = "1",
day = "1",
doi = "10.1097/01.SLA.0000071561.76384.19",
language = "English (US)",
volume = "237",
pages = "782--789",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Adjuvant Hepatic Arterial Chemotherapy Following Metastasectomy in Patients with Isolated Liver Metastases

AU - Onaitis, Mark

AU - Morse, Michael

AU - Hurwitz, Herbert

AU - Cotton, Peggy

AU - Tyler, Douglas

AU - Clavien, Pierre

AU - Clary, Bryan

AU - Blumgart, Leslie H.

AU - McMasters, Kelly M.

AU - Chapman, William C.

AU - Daly, John M.

AU - Onaitis, Mark W.

PY - 2003/1/1

Y1 - 2003/1/1

N2 - Objective: To examine survival and toxicity by querying a single-institutional experience with adjuvant hepatic arterial infusional (HAI) chemotherapy. Summary: Background Data Three randomized series in the literature have examined adjuvant HAI after complete resection of liver metastases. Only one of these trials showed an overall survival benefit at 2 years but not over the entire time period of the study. Previous studies in patients with unresectable disease were plagued by high rates of biliary toxicity. Methods: A retrospective review of a prospectively maintained database was performed. Hepatic arterial pumps were placed in the standard fashion. Patients received floxuridine at doses previously demonstrated as safe in the literature. Standard statistical methods were used. Results: Twenty-one of 92 patients underwent placement of hepatic arterial pumps at the time of liver resection. The HAI group was similar in all demographic measures to the non-HAI group, with the exception that the HAI patients were significantly younger. No differences were seen between the groups in either disease-free or overall survival, although a trend toward improved hepatic progression-free survival was noted. Significant biliary sclerosis developed in six patients in the HAI group, requiring chronic indwelling stents in four patients. One patient died of progressive liver failure associated with this toxicity. Conclusions: Biliary toxicity is an important potential side effect of hepatic arterial chemotherapy. Although larger randomized studies and this one suggest significant improvements in hepatic recurrences, these have not reliably translated into overall survival benefit. This fact, in light of the potential toxicity, would argue for a larger confirmatory trial of HAI in the adjuvant setting, incorporating recent advances in systemic therapy and careful attention to hepatotoxicity.

AB - Objective: To examine survival and toxicity by querying a single-institutional experience with adjuvant hepatic arterial infusional (HAI) chemotherapy. Summary: Background Data Three randomized series in the literature have examined adjuvant HAI after complete resection of liver metastases. Only one of these trials showed an overall survival benefit at 2 years but not over the entire time period of the study. Previous studies in patients with unresectable disease were plagued by high rates of biliary toxicity. Methods: A retrospective review of a prospectively maintained database was performed. Hepatic arterial pumps were placed in the standard fashion. Patients received floxuridine at doses previously demonstrated as safe in the literature. Standard statistical methods were used. Results: Twenty-one of 92 patients underwent placement of hepatic arterial pumps at the time of liver resection. The HAI group was similar in all demographic measures to the non-HAI group, with the exception that the HAI patients were significantly younger. No differences were seen between the groups in either disease-free or overall survival, although a trend toward improved hepatic progression-free survival was noted. Significant biliary sclerosis developed in six patients in the HAI group, requiring chronic indwelling stents in four patients. One patient died of progressive liver failure associated with this toxicity. Conclusions: Biliary toxicity is an important potential side effect of hepatic arterial chemotherapy. Although larger randomized studies and this one suggest significant improvements in hepatic recurrences, these have not reliably translated into overall survival benefit. This fact, in light of the potential toxicity, would argue for a larger confirmatory trial of HAI in the adjuvant setting, incorporating recent advances in systemic therapy and careful attention to hepatotoxicity.

UR - http://www.scopus.com/inward/record.url?scp=85047692576&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047692576&partnerID=8YFLogxK

U2 - 10.1097/01.SLA.0000071561.76384.19

DO - 10.1097/01.SLA.0000071561.76384.19

M3 - Article

VL - 237

SP - 782

EP - 789

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 6

ER -