Prospective phase II trial of combination hepatic artery infusion and systemic chemotherapy for unresectable colorectal liver metastases: Long term results and curative potential

摘要

Background/Objectives Combination hepatic artery infusion (HAI) and systemic (SYS) chemotherapy for unresectable CRLM results in high tumor‐response rates. This study represents an update of long‐term survival and conversion to resectability in patients with unresectable CRLM treated with HAI and SYS chemotherapy in a phase II study. Method The primary endpoint was complete resection. Multivariate and landmark analysis assessed the effect of complete resection on progression‐free (PFS) and overall survival (OS). Results From 2007 to 2012, 64 patients with median of 13 tumors were enrolled; 67% had prior chemotherapy. 33 patients (52%) were converted to resection. Median follow‐up among survivors was 81 months. Median PFS and OS were 13 and 38 months, respectively, with 5‐year‐OS of 36%. Chemotherapy‐na?ve patients had 5‐year‐OS of 51%. Conversion to resection was the only independent factor prognostic of improved PFS and OS. Nine of 64 patients (14%) are NED (five since initial resection, three after resection of recurrent disease, one from chemotherapy alone) at median follow‐up of 86 months from treatment initiation, and 72 months from last operative intervention. Conclusion Combination HAI and SYS is an effective therapy for high‐volume unresectable CRLM, resulting in a high rate of resection, long‐term survival, and the potential for cure.