Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer.

被引:697
作者
Kemeny, N
Huang, Y
Cohen, AM
Shi, WJ
Conti, JA
Brennan, MF
Bertino, JR
Turnbull, ADM
Sullivan, D
Stockman, J
Blumgart, LH
Fong, YM
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Med, New York, NY 10021 USA
[2] Mem Sloan Kettering Canc Ctr, Dept Biostat, New York, NY 10021 USA
[3] Mem Sloan Kettering Canc Ctr, Dept Surg, New York, NY 10021 USA
关键词
D O I
10.1056/NEJM199912303412702
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Two years after undergoing resection of liver metastases from colorectal cancer, about 65 percent of patients are alive and 25 percent are free of detectable disease. We tried to improve these outcomes by treating patients with hepatic arterial infusion of floxuridine plus systemic fluorouracil after liver resection. Methods: We randomly assigned 156 patients at the time of resection of hepatic metastases from colorectal cancer to receive six cycles of hepatic arterial infusion with floxuridine and dexamethasone plus intravenous fluorouracil, with or without leucovorin, or six weeks of similar systemic therapy alone. Patients were stratified according to previous treatment and the number of liver metastases identified at operation. The study end points were overall survival, survival without recurrence of hepatic metastases, and survival without any metastases at two years. Results: The actuarial rate of overall survival at two years was 86 percent in the group treated with combined therapy and 72 percent in the group given monotherapy alone (P = 0.03). The median survival was 72.2 months in the combined-therapy group and 59.3 months in the monotherapy group, with a median follow-up of 62.7 months. After two years, the rates of survival free of hepatic recurrence were 90 percent in the combined-therapy group and 60 percent in the monotherapy group (P < 0.001), and the respective rates of progression-free survival were 57 percent and 42 percent (P = 0.07). At two years, the risk ratio for death was 2.34 among patients treated with systemic therapy alone, as compared with patients who received combined therapy (95 percent confidence interval, 1.10 to 4.98; P = 0.027), after adjustment for important variables. The rates of adverse effects of at least moderate severity were similar in the two groups, except for a higher frequency of diarrhea and hepatic effects in the combined-therapy group. Conclusions: For patients who undergo resection of liver metastases from colorectal cancer, postoperative treatment with a combination of hepatic arterial infusion of floxuridine and intravenous fluorouracil improves the outcome at two years. (N Engl J Med 1999;341:2039-48.) (C)1999, Massachusetts Medical Society.
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页码:2039 / 2048
页数:10
相关论文
共 41 条
  • [31] QUANTITATION OF INTRATUMORAL THYMIDYLATE SYNTHASE EXPRESSION PREDICTS FOR RESISTANCE TO PROTRACTED INFUSION OF 5-FLUOROURACIL AND WEEKLY LEUCOVORIN IN DISSEMINATED COLORECTAL CANCERS - PRELIMINARY-REPORT FROM AN ONGOING TRIAL
    LEICHMAN, L
    LENZ, HJ
    LEICHMAN, CG
    GROSHEN, S
    DANENBERG, K
    BARANDA, J
    SPEARS, CP
    BOSWELL, W
    SILBERMAN, H
    ORTEGA, A
    STAIN, S
    BEART, R
    DANENBERG, P
    [J]. EUROPEAN JOURNAL OF CANCER, 1995, 31A (7-8) : 1306 - 1310
  • [32] MARTIN JK, 1990, ARCH SURG-CHICAGO, V125, P1022
  • [33] Nordlinger B, 1996, CANCER, V77, P1254, DOI 10.1002/(SICI)1097-0142(19960401)77:7<1254::AID-CNCR5>3.3.CO
  • [34] 2-R
  • [35] HEPATIC ARTERIAL INFUSION OF FLOXURIDINE IN PATIENTS WITH LIVER METASTASES FROM COLORECTAL-CARCINOMA - LONG-TERM RESULTS OF A PROSPECTIVE RANDOMIZED TRIAL
    ROUGIER, P
    LAPLANCHE, A
    HUGUIER, M
    HAY, JM
    OLLIVIER, JM
    ESCAT, J
    SALMON, R
    JULIEN, M
    AUDY, JCR
    GALLOT, D
    GOUZI, JL
    PAILLER, JL
    ELISA, D
    LACAINE, F
    ROOS, S
    ROTMAN, N
    LUBOINSKI, M
    LASSER, P
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 1992, 10 (07) : 1112 - 1118
  • [36] HEPATIC METASTASES FROM COLORECTAL-CARCINOMA - IMPACT OF SURGICAL RESECTION ON THE NATURAL-HISTORY
    SCHEELE, J
    STANGL, R
    ALTENDORFHOFMANN, A
    [J]. BRITISH JOURNAL OF SURGERY, 1990, 77 (11) : 1241 - 1246
  • [37] SIGURDSON ER, 1991, P AN M AM SOC CLIN, V10, P140
  • [38] VANOOIJEN B, 1992, CANCER-AM CANCER SOC, V70, P28, DOI 10.1002/1097-0142(19920701)70:1<28::AID-CNCR2820700105>3.0.CO
  • [39] 2-9
  • [40] A PROSPECTIVE, RANDOMIZED EVALUATION OF THE TREATMENT OF COLORECTAL-CANCER METASTATIC TO THE LIVER
    WAGMAN, LD
    KEMENY, MM
    LEONG, L
    TERZ, JJ
    HILL, LR
    BEATTY, JD
    KOKAL, WA
    RIIHIMAKI, DU
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 1990, 8 (11) : 1885 - 1893