Metastases hepatiques des cancers colorectaux: Chimiotherapies intra-arterielles. Interet et indications

Intraarterial hepatic chemotherapy (IAHC) increases the tumoral exposure of the liver metastases to cytotoxic agents. IAHC may be used in case of non resectable and isolated liver metastases from colorectal origin. It gives a tumor response rate of about 50%. Seven phase III trials and a recent metaanalysis testing IAHC using FUDR demonstrated its superiority over systemic chemotherapy using FUDR or bolus 5FU in terms of response rate and an increase in survival compared to symptomatic treatment. IAHC drawbacks are the biliary toxicity observed with some protocols, the development of extrahepatic metastasis and its cost. The ongoing protocols aim to improve the IAHC efficacy and tolerance and are frequently associated to systemic chemotherapy. The discovery of new active products in colorectal cancer and the optimisations of combinations of 5FU and leucovorin in terms of efficacy stimulate research aimed at developing more active combinations of IAHC and active systemic chemotherapy. The best IAHC indications are presently unresectable hepatic metastases from colorectal cancer without extra-hepatic metastases, with less than 50% liver involvement, with a CEA level under 100 ng/ml.