[Adjuvant arterial infusion chemotherapy for patients with biliary cancer]

Although surgery is the only potentially curative treatment for biliary cancer, patients frequently develop liver metastasis, local recurrence, and peritoneal metastasis after complete resection. Liver metastasis is a common mode of progression for biliary cancer, and the prognosis is extremely poor when it occurs. Between January 2000 and December 2003, 18 out of 37 patients received adjuvant arterial infusion chemotherapy after curative resection of biliary cancer. Nine of these 18 patients had bile duct cancer, seven had gallbladder cancer, and two had cancer of the papilla of Vater. A catheter was placed using Seldinger's technique, with the tip being advanced into the common hepatic artery via the femoral artery. Then 1,000 mg/body of 5-FU was administered as a 24-hour continuous infusion on days 1-3 and 5-7. Two cycles of this chemotherapy were delivered through an angiography catheter without using a reservoir port. This treatment caused no severe systemic or abdominal complications. The two groups were well balanced with respect to prognostic factors. The 1-year survival rate was 76.2% in the adjuvant chemotherapy group versus 52.7% in the non-adjuvant chemotherapy group, while the 3-year survival rates were 47.6% and 39.5%, respectively (Wilcoxon test, p=0.048). Median overall survival was superior in the adjuvant chemotherapy group and the difference was significant. High-dose arterial infusion of 5-FU seems to be a safe, tolerable, and effective regimen for preventing the postoperative recurrence of biliary cancer.