Abstracts
2000 Digestive Disease Week

# 2246 Multi Option Therapeutic Strategy for Hepatic Metastases of Colorectal Cancer.
Harold J. Wanebo, Clarence Soderberg, Michael P. Vezeridis, Audrey Levy, Providence, RI

Although resection of hepatic metastases from colorectal cancer is associated with a survival of 25%-35% in most large series, resectability is often negated by the presence of undetected metastases in the liver or the porta hepatis which would render the patient unresectable and negate the value of that procedure. To optimize the value of this procedure to the patient, we have long adopted a policy of having alternative therapeutic strategies in the event of non-resectability. Primarily, we have utilized planned hepatic artery catheter insertion with attachment to a pump or a port to facilitate subsequent hepatic artery infusion (HAI) in these patients with large lesions. Methods: Patient selection for resection of hepatic metastases is based on standard clinical and radiologic imaging studies and on operative findings. Standard imaging with CT or MRI scans preoperatively plus CEA levels and the liberal use of arteriography and intraoperative ultrasound facilitate patient selection. Patients selected for HAI are treated for 10 days with the following protocol: FUdR 0.3mg/M2/d + Leucovorin (LV) 20mg/ M2/d + Dexamethasone 20mg/d alternating with Continuous Infusion (CI), 5FU 200/300mg/M2/d x 14d and LV 20mg/M2/d x 14d. Results: Hepatic resection was performed on 86 patients; 60 days peri-operative mortality occured in 6 patients (6.9%). the median and 5 year survival was 49 months and 37%. There were 18 patients with non-resectable liver metastases, who were treated with HAI alternating with systemic therapy. The objective response (50% tumor regression) was 67%. The median and 5 year survival was 24 months and 0%. A historic central database of 136 patients with untreated colorectal metastase had a median survival of 8 months. Conclude: A multi-option therapeutic strategy is essential in surgical planning for management of colorectal cancer metastatic to the liver. Resection is still optimum therapy with general survival expectations in the 30- 37% range with acceptable peri-operative mortality. In the event of nonresectability, HAI with response of 67% and 24 mos. median survival provides excellent palliation and ensures that the operative procedure is maximized (not wasted) in these high-risk patients.