A combined treatment approach to management of hepatic metastasis

Forty-eight patients with liver metastases were treated at Rhode ISland Hospital in a nonrandomized sequential manner between January 1972 and June 1977. Eight received 5 FUDR hepatic artery infusion, 14 hepatic irradiation, and 25 were planned for combined intra-arterial chemotherapy plus total hepatic irradiation. Those patients who successfully completed induction treatments had a median survival in the radiation only group of 140 days, in the intra-arterial chemotherapy group 270 days, and in the combined group 376 days. Hepatic radiation when combined with chemotherapy was well tolerated. Primary tumor site, disease duration, and degree of abnormality of liver function had no relationship to the response to treatment. The pretreatment performance level of the patient as determined by the Karnofsky Performance Index gave the best indication for potential response to combined therapy. Based on the results of this treatment and the reports of other series, it appears that the combination of intra-arterial 5 FUDR plus hepatic irradiation may offer prolonged and worthwhile palliation to appropriately chosen patients.