[Device for intraarterial access for locoregional chemotherapy in hepatic metastasis from colorectal neoplasms...

Metastasis are the most common malignant lesions of the liver. Liver is the most common site of visceral metastasis from colo-rectal carcinoma. Only in few patients are the lesions surgically resectable for cure and standard intravenous chemotherapy produces a low response rate. An intrahepatic arterial device for regional chemotherapy is an effective and safe alternative for unresectable liver metastasis from colorectal carcinoma, with a significant improvement on response rates compared with conventional i.v. chemotherapy; a longer survival is also reported in patients receiving intrahepatic therapy, even if the difference is not statistically significant. The catheter is inserted through the gastro-duodenal artery and the reservoir is placed in a subcutaneous pocket on the anterior thoracic wall. The Authors discuss indications, implantation technique and complications. Intra-arterial chemotherapy is administered in ambulatorial regimen and scintigraphic scanning and/or epatic ultrasonography are performed every three months to evaluate response rate. Median survival is variable from 12 to 17 months in the different series with response rates (disappeared metastases or tumor-mass reduction over 50%) of 48%-62%. The increased tumor responses reported together with a lower systemic toxicity (compared with systemic therapy) suggest that intra-arterial chemotherapy is a reliable and well tolerated treatment.