CHIMIOTHERAPIE INTRA-ARTERIELLE HEPATIQUE. EXPERIENCE DE 200 CAS

Objectives. - This retrospective study had three aims: a) to investigate whether one catheter, whatever the number of hepatic arteries, associated with miscellaneous arterial ligations, produced the same results as the implantation of multiple catheters, b) to study the survival rate after intra-arterial chemotherapy, and c) based on a multifactorial study of prognostic factors, to define the best indications of this treatment in the future. Methods. - Two hundred catheters were surgically implanted to perform intrahepatic arterial chemotherapy in patients with multiple unresectable isolated liver tumors. The origins of these tumours were colorectal cancer in 152 cases, neuroendocrine tumour in 13 cases, hepatocellular carcinoma in 9 cases, and miscellaneous tumours in 22 cases. The hepatic arteries were ligated in 32% of the cases. Resection of the primary or local recurrence was performed at the same time in respectively 41% and 16% of the cases. Results - The use of only one catheter was always possible, and the ligations of miscellaneous accessory hepatic arteries did not modify the therapeutic results. There were no postoperative deaths. Numerous complications occurred during local chemotherapy, mainly digestive and hepatobiliary complications (38.5% of the cases). Early discontinuation of local chemotherapy was due to the occurrence of thrombosis of the hepatic artery in 23% of the cases (after a mean delay of 5.2 months) and to the occurrence of digestive or hepato-biliary complications in 11% of the cases. The rate of objective response was 44%, with 22 complete and 62 partial responses on morphologic examination. The crude survival rates were 65 ± 3% at 1 year, 33 ± 4% at 2 years and 5 ± 2% at 5 years, with a median survival of 16 months. The median survival was different according to the primary tumour (34 months for neuroendocrine tumours, 17 months for colorectal tumours and 12 months for hepatocellular and miscellaneous carcinomas). For the 152 colorectal cancers, a multifactorial study identified 2 main independent adverse prognostic factors: an involvement of the liver greater than 50% (P = 0.006) and circulating carcinoembryonic antigen > 100 ng/L (P = 0.001). Conclusions - The implantation of only one arterial catheter is technically possible in all cases, and the ligation of accessory hepatic arteries does not modify the therapeutic results. The current indications of local chemotherapy are liver metastases of colorectal origin which do not involve more than 50% of the liver and with a circulating carcinoembryonic antigen < 100 ng/L.