Hepatic Chemotherapy

Standard treatment in most Centres for colorectal liver secondaries involves intravenous (IV) chemotherapy. While the response rates for the newer forms of chemotherapy are very much better than was previously the case, the benefit is most often maintained for only six to eight months and most patients will experience unpleasant side effects. Without treatment average survival is generally only 6-12 months, and this can be improved to around 20-24 months using aggressive systemic chemotherapy. It is however possible to infuse chemotherapy directly into the liver via the hepatic artery with very good results. This allows a large dose of drug to be given, with very little in the way of side effects. All studies done comparing this method of chemotherapy delivery with IV chemotherapy have confirmed better response rates, fewer side effects and better survival, than when the same drug is given systemically. Use of hepatic artery chemotherapy around the world has waned in recent years, because of the increase benefit seen with newer systemic chemotherapy agents, but it still has a valuable place when used alongside other treatments such as cryotherapy or SIRT. We believe these approaches are best taken in those with liver-only secondaries, thus avoiding side effects at that stage, and preserving the option of systemic chemotherapy for a later date, when further spread has taken place. Such an approach allows patients to obtain maximum benefit from a variety of treatments, and is likely to thereby enhance survival, in what is currently an incurable disease.

Whereas we at the Wakefield Clinic used to use this form of treatment on its own, we now prefer to use it in conjunction with either hepatic cryotherapy or SIRT (see above). By so doing we think the results can be improved. An operation is still required to place a special device (Portacath) under the skin so that when chemotherapy is given via the port, it goes directly into the artery to the liver. This operation is a major one but does not carry many risks. The risk of dying having the surgery is less than 1%. We give four days of chemotherapy each four weeks for 6-12 months. Patients are able to carry on fairly normally during this time, at home or at work, and seldom experience any side effects.

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