REGIONAL THERAPY FOR LIVER METASTASES OF BREAST-CARCINOMA

The prognosis of patients with metastatic breast cancer in particular with an involvement of the liver has to be regarded as rather unfavourable. Up today no convincing therapy for patients with breast cancer and liver metastases could be found. From 1982 to 199142 patients with suspicion on liver metastases of a primary breast cancer were laparotomized. At that time 20 patients already had an extrahepatic formation of metastases. In contrast to the preexaminations an histologically benign liver tumor was intraoperatively verified in 6 patients. In the other 36 patients the operation was finished in 9 cases as explorative laparotomy (group A) because of extensive intra- and extrahepatic manifestation and/or vessel abnormalities. In 19 cases an arterial catheter system with subcutaneous port was implanted (group B). Partial liver resection combined with intraarterial catheter implantation was performed in 8 patients (group C). Postoperatively 27 patients monthly received a regional combined chemotherapy (groups B+C); a modified FAM scheme (5-Fluorouracil: 1000 mg/12 h/d/2 d, Adriamycin: 20 mg/12 h/d/3 d, Mitomycin C: 10 mg/2 h/d/1 d) was used. Response could be documented in 12 out of 17 evaluable patients (70,6 %. A median overall postoperative survival time of 14.5 months for all patients in case of a proved liver metastases was calculated. A prolongation could not be realized, neither in patients with partial liver resection with regional therapy (group 6) nor in patients with an intraarterial chemotherapy (group B). Only in exceptional cases a successful regional chemotherapy could influence the course favourable. As patients with liver metastases besides the psychological stress often complain about the compression of the stomach and abdominal pain, a partial liver resection or a regional chemotherapy might be reasonable due to low morbidity after failure of the conventional therapies. Regional chemotherapy or partial liver resection in case of a breast carcinoma, however, should be reserved only for patients enrolled in randomized or at least prospective studies.