A systematic review of hepatic artery chemotherapy after hepatic resection of colorectal cancer metastatic to the liver

PURPOSE: Colorectal cancer metastatic to the liver, when technically feasible, is resected with a moderate chance of cure. The most common site of failure after resection is in the remaining liver. To enhance survival, chemotherapy has been delivered directly to the liver postresection via the hepatic artery. This study was designed to assess the effect of posthepatic resection, hepatic artery chemotherapy on overall survival. METHODS: Trials were sought in Medline, the Cochrane Controlled Trial Register, The Cochrane Hepatobitiary Group Trials Register, and through contact of trial authors and reference lists using key words: colorectal, cancer, hepatic metastases, hepatic artery, chemotherapy, and randomized. Trials were chosen in which patients having resection of colorectal cancer metastatic to the liver were randomized to hepatic artery chemotherapy or any alternative treatment. Survival data were obtained principally from abstraction from survival curves in published studies using the method of Parmar to calculate a study-specific, log-hazard ratio and then combined-effect, log-hazard ratio, as well as a combined Kaplan-Meier survival probability curve. RESULTS: Overall survival at five years in the hepatic artery group was 45 percent and 40 percent in the control group. Forty-three individuals developed recurrent liver metastases in the hepatic artery chemotherapy group, and 97 developed liver recurrence in the control group. However, no significant advantage was found in the meta-analysis for hepatic artery chemotherapy measuring overall survival and calculating survival based on "intention to treat" (log-hazard ratio = 0.0848, favoring the control group; 95 percent confidence interval = +/-0.2037). Adverse events related to hepatic artery therapy were common, including five therapy-related. deaths. CONCLUSIONS: Although recurrence in the remaining liver happened less frequently in the hepatic artery chemotherapy group, overall survival was not improved. The log-hazard ratio even favored the control group, although not significantly. This added intervention for the treatment of metastatic colorectal cancer cannot be recommended at this time. [Key words: Colorectal cancer; Liver metastases resection; Hepatic artery chemotherapy; Meta-analysis]