Concomitant hepatic radiation and intraarterial fluorinated pyrimidine therapy: Correlation of liver scan, liver function tests, and plasma CEA with tumor response

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Abstract
Patients (16) with metastatic disease to the liver (12 colorectal and 4 unknown primary tumors) were treated in a pilot study of hepatic irradiation (2500-3000 rad in 10-12 fractions) delivered concomitantly with continuous short-term intraarterial infusion of 5-fluorouracil (1 g/d) or FUDR [2''-deoxy-5-fluorouridine] (0.5 mg/kg per day) via a percutaneously placed hepatic artery catheter. Abnormal liver function tests, including SGOT [serum glutamic oxaloacetic transaminase], LDH [lactic dehydrogenase], and alkaline phosphatase, decreased in all patients by day 7-10 of treatment, and other metabolic factors, including serum cholesterol, calcium, albumin, phosphorous and uric acid also decreased, often to subnormal levels by termination of treatment (days 15-20). These chemical alterations did not correlate with tumor response in that the identical pattern was observed in responders (10 patients) and nonresponders (6 patients). Objective determinants of response were assessed by serial monitoring of plasma carcinoembryonic antigen (CEA) and liver scan. In 14 patients with elevated CEA levels, tumor response (9 patients), nonresponse (4 patients) and relapse (5 patients) were predicted and confirmed by sequential monitoring of CEA. In 1 patient a paradoxical decrease in plasma CEA was associated with progressive disease. The liver scan identified all responding patients but was difficult to quantitate and was delayed for months following subjective clinical response and changes in plasma CEA levels.