Hepato-Gastroenterology Department, Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France.
Oncology Center Eugène Marquis, Rennes, France.
Clin Colorectal Cancer. 2017 Dec;16(4):308-315. doi: 10.1016/j.clcc.2017.03.003. Epub 2017 Mar 14.
Hepatic arterial infusion chemotherapy (HAIC) is a treatment used for liver metastases (LM) of colorectal cancer (CRC). Because of its technical conditions, it has been used in only a few experienced centers in France. Our aim was to evaluate its feasibility, efficacy and tolerance in 4 centers.
Clinical, biological, and radiological data of patients treated with HAIC for unresectable LM from CRC in 4 institutions from October 2011 to January 2016 were retrospectively analyzed.
Sixty-one patients with unresectable LM from CRC were included. Patients had previously received systemic chemotherapy in 95% of patients and 82.8% had previous oxaliplatin treatment. Oxaliplatin was administered using an intra-arterial route combined with intravenous (I.V.) Five-fluorouracil (5-FU) with leucovorin alone in 43.3% of patients, or combined with other I.V. chemotherapies or monoclonal antibodies in 56.7% of patients. Grade 3 to 4 clinical toxicities were reported in 16% of patients, including 9.8% of neurotoxicity, and Grade 3 to 4 biological toxicities were reported in 24.6% of patients including 22.2% with neutropenia. Catheter-related complications were observed in 31.1%. Tumor response rate in first- and second-line was 26.5% and third- and fourth-line was 11%. Median overall survival (OS) in first- and second-line was 13.5 months and third- and fourth-line was 8.3 months (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.39-1.12; P = .1729). Median progression-free survival (PFS) in first- and second-line was 9 months and third- and fourth-line were 6 months (HR, 0.53; 95% CI, 0.18-0.659; P = .0037). A secondary R0 resection was possible in 10 cases (16.4%) allowing a 2-year survival of 80%.
These data confirm that in centers that recently developed HAIC using oxaliplatin, this treatment is feasible and has acceptable tolerance. The results, in terms of hepatic PFS, PFS, OS, and the rate of secondary resections of LM, are in the range of published data, and they confirm the interest of HAIC in patients in progression after multiple I.V.
肝动脉灌注化疗（HAIC）是一种用于结直肠癌（CRC）肝转移（LM）的治疗方法。由于其技术条件，仅在法国的少数几个经验丰富的中心使用。我们的目的是在 4 个中心评估其可行性、疗效和耐受性。
回顾性分析 2011 年 10 月至 2016 年 1 月 4 家机构接受 HAIC 治疗不可切除的结直肠癌 LM 的患者的临床、生物学和影像学数据。
共纳入 61 例不可切除的结直肠癌 LM 患者。95%的患者之前接受过全身化疗，82.8%的患者之前接受过奥沙利铂治疗。奥沙利铂通过动脉途径给药，联合静脉（I.V.）氟尿嘧啶（5-FU）和亚叶酸，43.3%的患者单独使用，56.7%的患者联合其他 I.V.化疗药物或单克隆抗体。16%的患者出现 3-4 级临床毒性，包括 9.8%的神经毒性，24.6%的患者出现 3-4 级生物学毒性，包括 22.2%的中性粒细胞减少症。31.1%的患者发生导管相关并发症。一线和二线治疗的肿瘤反应率为 26.5%，三线和四线治疗的肿瘤反应率为 11%。一线和二线的中位总生存期（OS）为 13.5 个月，三线和四线的中位 OS 为 8.3 个月（风险比[HR]，0.66；95%置信区间[CI]，0.39-1.12；P=0.1729）。一线和二线的中位无进展生存期（PFS）为 9 个月，三线和四线的中位 PFS 为 6 个月（HR，0.53；95%CI，0.18-0.659；P=0.0037）。10 例（16.4%）患者可进行二次 R0 切除，可获得 2 年 80%的生存率。
这些数据证实，在最近使用奥沙利铂开展 HAIC 的中心，这种治疗是可行的，且具有可接受的耐受性。在肝 PFS、PFS、OS 和 LM 二次切除率方面的结果与已发表的数据相当，这证实了 HAIC 在接受多次静脉化疗后进展的患者中的意义。
