Hepatic Arterial Infusion in Combination with Modern Systemic Chemotherapy is Associated with Improved Survival Compared with Modern Systemic Chemotherapy Alone in Patients with Isolated Unresectable Colorectal Liver Metastases: A Case–Control Study

Mashaal Dhir, Heather L. Jones, Yongli Shuai, Amber K. Clifford, Samantha Perkins, Jennifer Steve, Melissa E. Hogg, M. Haroon A. Choudry, James F. Pingpank, Matthew P. Holtzman, Herbert J. Zeh, Nathan Bahary, David L. Bartlett, Amer H. Zureikat

Research output: Contribution to journalArticle

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Abstract

Background: In the era of effective modern systemic chemotherapy (CT), the role of hepatic arterial infusion of fluoxuridine (HAI-FUDR) in the treatment of isolated unresectable colorectal liver metastasis (IU-CRCLM) remains controversial. This study aimed to compare the overall survival (OS) of HAI-FUDR in combination with modern systemic CT versus modern systemic CT alone in patients with IU-CRCLM. Methods: This was a case–control study of IU-CRCLM patients who underwent HAI + modern systemic CT or modern systemic CT alone. Modern systemic CT was defined as the use of multidrug regimens containing oxaliplatin and/or irinotecan ± biologics. Results: Overall, 86 patients met the inclusion criteria (n = 40 for the HAI + CT group, and n = 46 for the CT-alone group). Both groups were similar in demographics, primary and stage IV tumor characteristics, and treatment-related variables (carcinoembryonic antigen, use of biologic agents, total number of lines of systemic CT administered) (all p > 0.05). Additionally, both groups were comparable with respect to liver tumor burden [median number of lesions (13.5 vs. 15), percentage of liver tumor replacement (37.5 vs. 40 %), and size of largest lesion] (all p > 0.05). Median OS in the HAI + CT group was 32.8 months compared with 15.3 months in the CT-alone group (p < 0.0001). Multivariate analysis revealed HAI + CT (hazard ratio 0.4, 95 % confidence interval 0.21–0.72; p = 0.003), Eastern Cooperative Oncology Group status, and receipt of increasing number of lines of systemic CT to be independent predictors of survival. Conclusions: In this case–control study of patients with IU-CRCLM, HAI in combination with CT was associated with improved OS when compared with modern systemic CT alone.

Original languageEnglish (US)
Pages (from-to)150-158
Number of pages9
JournalAnnals of Surgical Oncology
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

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Neoplasm Metastasis
Drug Therapy
Survival
Liver
oxaliplatin
Carcinoembryonic Antigen
Biological Factors
Combination Drug Therapy
Tumor Burden
Neoplasms
Multivariate Analysis
Demography
Confidence Intervals
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Hepatic Arterial Infusion in Combination with Modern Systemic Chemotherapy is Associated with Improved Survival Compared with Modern Systemic Chemotherapy Alone in Patients with Isolated Unresectable Colorectal Liver Metastases : A Case–Control Study. / Dhir, Mashaal; Jones, Heather L.; Shuai, Yongli; Clifford, Amber K.; Perkins, Samantha; Steve, Jennifer; Hogg, Melissa E.; Choudry, M. Haroon A.; Pingpank, James F.; Holtzman, Matthew P.; Zeh, Herbert J.; Bahary, Nathan; Bartlett, David L.; Zureikat, Amer H.

In: Annals of Surgical Oncology, Vol. 24, No. 1, 01.01.2017, p. 150-158.

Research output: Contribution to journalArticle

Dhir, Mashaal ; Jones, Heather L. ; Shuai, Yongli ; Clifford, Amber K. ; Perkins, Samantha ; Steve, Jennifer ; Hogg, Melissa E. ; Choudry, M. Haroon A. ; Pingpank, James F. ; Holtzman, Matthew P. ; Zeh, Herbert J. ; Bahary, Nathan ; Bartlett, David L. ; Zureikat, Amer H. / Hepatic Arterial Infusion in Combination with Modern Systemic Chemotherapy is Associated with Improved Survival Compared with Modern Systemic Chemotherapy Alone in Patients with Isolated Unresectable Colorectal Liver Metastases : A Case–Control Study. In: Annals of Surgical Oncology. 2017 ; Vol. 24, No. 1. pp. 150-158.
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title = "Hepatic Arterial Infusion in Combination with Modern Systemic Chemotherapy is Associated with Improved Survival Compared with Modern Systemic Chemotherapy Alone in Patients with Isolated Unresectable Colorectal Liver Metastases: A Case–Control Study",
abstract = "Background: In the era of effective modern systemic chemotherapy (CT), the role of hepatic arterial infusion of fluoxuridine (HAI-FUDR) in the treatment of isolated unresectable colorectal liver metastasis (IU-CRCLM) remains controversial. This study aimed to compare the overall survival (OS) of HAI-FUDR in combination with modern systemic CT versus modern systemic CT alone in patients with IU-CRCLM. Methods: This was a case–control study of IU-CRCLM patients who underwent HAI + modern systemic CT or modern systemic CT alone. Modern systemic CT was defined as the use of multidrug regimens containing oxaliplatin and/or irinotecan ± biologics. Results: Overall, 86 patients met the inclusion criteria (n = 40 for the HAI + CT group, and n = 46 for the CT-alone group). Both groups were similar in demographics, primary and stage IV tumor characteristics, and treatment-related variables (carcinoembryonic antigen, use of biologic agents, total number of lines of systemic CT administered) (all p > 0.05). Additionally, both groups were comparable with respect to liver tumor burden [median number of lesions (13.5 vs. 15), percentage of liver tumor replacement (37.5 vs. 40 {\%}), and size of largest lesion] (all p > 0.05). Median OS in the HAI + CT group was 32.8 months compared with 15.3 months in the CT-alone group (p < 0.0001). Multivariate analysis revealed HAI + CT (hazard ratio 0.4, 95 {\%} confidence interval 0.21–0.72; p = 0.003), Eastern Cooperative Oncology Group status, and receipt of increasing number of lines of systemic CT to be independent predictors of survival. Conclusions: In this case–control study of patients with IU-CRCLM, HAI in combination with CT was associated with improved OS when compared with modern systemic CT alone.",
author = "Mashaal Dhir and Jones, {Heather L.} and Yongli Shuai and Clifford, {Amber K.} and Samantha Perkins and Jennifer Steve and Hogg, {Melissa E.} and Choudry, {M. Haroon A.} and Pingpank, {James F.} and Holtzman, {Matthew P.} and Zeh, {Herbert J.} and Nathan Bahary and Bartlett, {David L.} and Zureikat, {Amer H.}",
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T1 - Hepatic Arterial Infusion in Combination with Modern Systemic Chemotherapy is Associated with Improved Survival Compared with Modern Systemic Chemotherapy Alone in Patients with Isolated Unresectable Colorectal Liver Metastases

T2 - A Case–Control Study

AU - Dhir, Mashaal

AU - Jones, Heather L.

AU - Shuai, Yongli

AU - Clifford, Amber K.

AU - Perkins, Samantha

AU - Steve, Jennifer

AU - Hogg, Melissa E.

AU - Choudry, M. Haroon A.

AU - Pingpank, James F.

AU - Holtzman, Matthew P.

AU - Zeh, Herbert J.

AU - Bahary, Nathan

AU - Bartlett, David L.

AU - Zureikat, Amer H.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: In the era of effective modern systemic chemotherapy (CT), the role of hepatic arterial infusion of fluoxuridine (HAI-FUDR) in the treatment of isolated unresectable colorectal liver metastasis (IU-CRCLM) remains controversial. This study aimed to compare the overall survival (OS) of HAI-FUDR in combination with modern systemic CT versus modern systemic CT alone in patients with IU-CRCLM. Methods: This was a case–control study of IU-CRCLM patients who underwent HAI + modern systemic CT or modern systemic CT alone. Modern systemic CT was defined as the use of multidrug regimens containing oxaliplatin and/or irinotecan ± biologics. Results: Overall, 86 patients met the inclusion criteria (n = 40 for the HAI + CT group, and n = 46 for the CT-alone group). Both groups were similar in demographics, primary and stage IV tumor characteristics, and treatment-related variables (carcinoembryonic antigen, use of biologic agents, total number of lines of systemic CT administered) (all p > 0.05). Additionally, both groups were comparable with respect to liver tumor burden [median number of lesions (13.5 vs. 15), percentage of liver tumor replacement (37.5 vs. 40 %), and size of largest lesion] (all p > 0.05). Median OS in the HAI + CT group was 32.8 months compared with 15.3 months in the CT-alone group (p < 0.0001). Multivariate analysis revealed HAI + CT (hazard ratio 0.4, 95 % confidence interval 0.21–0.72; p = 0.003), Eastern Cooperative Oncology Group status, and receipt of increasing number of lines of systemic CT to be independent predictors of survival. Conclusions: In this case–control study of patients with IU-CRCLM, HAI in combination with CT was associated with improved OS when compared with modern systemic CT alone.

AB - Background: In the era of effective modern systemic chemotherapy (CT), the role of hepatic arterial infusion of fluoxuridine (HAI-FUDR) in the treatment of isolated unresectable colorectal liver metastasis (IU-CRCLM) remains controversial. This study aimed to compare the overall survival (OS) of HAI-FUDR in combination with modern systemic CT versus modern systemic CT alone in patients with IU-CRCLM. Methods: This was a case–control study of IU-CRCLM patients who underwent HAI + modern systemic CT or modern systemic CT alone. Modern systemic CT was defined as the use of multidrug regimens containing oxaliplatin and/or irinotecan ± biologics. Results: Overall, 86 patients met the inclusion criteria (n = 40 for the HAI + CT group, and n = 46 for the CT-alone group). Both groups were similar in demographics, primary and stage IV tumor characteristics, and treatment-related variables (carcinoembryonic antigen, use of biologic agents, total number of lines of systemic CT administered) (all p > 0.05). Additionally, both groups were comparable with respect to liver tumor burden [median number of lesions (13.5 vs. 15), percentage of liver tumor replacement (37.5 vs. 40 %), and size of largest lesion] (all p > 0.05). Median OS in the HAI + CT group was 32.8 months compared with 15.3 months in the CT-alone group (p < 0.0001). Multivariate analysis revealed HAI + CT (hazard ratio 0.4, 95 % confidence interval 0.21–0.72; p = 0.003), Eastern Cooperative Oncology Group status, and receipt of increasing number of lines of systemic CT to be independent predictors of survival. Conclusions: In this case–control study of patients with IU-CRCLM, HAI in combination with CT was associated with improved OS when compared with modern systemic CT alone.

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