Hepatic Arterial Infusion after Liver Resection

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Abstract
In 1999, we reported on the results of a randomized study of adjuvant therapy after liver resection for metastatic colorectal cancer.1 One group of patients was treated with hepatic arterial infusion with floxuridine and dexamethasone plus systemic fluorouracil, with or without leucovorin (combined therapy). The other group received systemic therapy alone, consisting of fluorouracil with or without leucovorin (monotherapy). We reported an increase in two-year survival for the combined-therapy group as compared with the group receiving monotherapy. We also reported a significant increase in the rate of survival free of hepatic progression in the combined-therapy group. All patients have now been followed for a minimum of 6 years, with a median follow-up of 10.3 years. Overall progression-free survival is now significantly greater in the combined-therapy group than in the monotherapy group (31.3 vs. 17.2 months, P=0.02). The median survival free of hepatic progression has not yet been reached in the combined-therapy group, whereas it has reached 32.5 months in the monotherapy group (P<0.01). Median overall survival is now 68.4 months (95 percent confidence interval, 55.2 to not reached) in the group receiving combined therapy and 58.8 months (95 percent confidence interval, 42.0 to 85.2) in the monotherapy group (P=0.10). Ten-year survival rates are 41.1 percent and 27.2 percent, respectively ( Figure 1 ). Toxicity since our first report includes late biliary toxic effects in two additional patients.