Hepatic Arterial Infusion of Chemotherapy for Hepatic Metastases
Background: Sixty percent of colon cancer patients develop liver metastasis. Only 25% of those have potentially resectable hepatic metastases, and approximately 58% of those patients relapse.
Methods: We review the indications and the technical aspects of hepatic artery infusion (HAI) of chemotherapy, as well as the efficacy, morbidity, and outcomes.
Results: HAI of chemotherapy has been used following hepatic metastasectomy, in patients with unresectable metastases, or in combination with other agents. Floxuridine, the chemotherapeutic agent most studied, is administered through an implantable subcutaneous infusion pump connected to a surgically placed hepatic artery catheter, which delivers the chemotherapeutic agents at a slow fixed rate. Treatment-related toxicities include chemical hepatitis, biliary sclerosis, and peptic ulceration. Some trials report a survival benefit for HAI over systemic chemotherapy with acceptable toxicity.
Conclusions: Regional perfusion chemotherapy can be logistically and technically complicated to deliver. The development of newer systemic agents with superior efficacy in the treatment of metastatic colorectal cancer will likely diminish the role of regional perfusion therapy in the future.

In 2005, an estimated 145,000 new cases of colorectal cancer will be diagnosed in the United States, with over 54,000 deaths caused by this disease. Sixty percent of patients develop liver metastasis,and for a third of those it is the sole site of disease. If untreated, the median survival is approximately 6 to 12 months, with no survivors at 5 years. Survival rates of up to 37% at 5 years and up to 22% at 10 years were reported with hepatic resection for metastatic colorectal cancer. Only 25% of patients with colorectal carcinoma have potentially curative resectable hepatic metastases, and approximately 58% of those patients relapse. To treat suspected micro-metastases in the remaining liver, prevent other metastasis, and improve survival, the use of regional chemotherapy alone (hepatic arterial infusion [HAI]) or in combination with systemic chemotherapy has been evaluated in a number of prospective randomized and nonrandomized studies. This review briefly describes the indication and technical aspects of HAI. It also reviews the data regarding the efficacy and the morbidity associated with this form of therapy when employed after hepatic metastasectomy, unresectable metastases, or in combination with other agents.