In numerous
tumors,
metastasis can be limited to the liver. In non-resectable patients, regional treatment modalities, especially arterial
cytostatic infusion, are favored in contrast to systemic
chemotherapy, whereas intraportal or intraperitoneal application is not successful. Improved results with high response rates have been reported after development of intra-arterial (i.a.) long-term regimens with
FUdR in patients with colorectal liver
metastases using implantable pumps and ports. However, a survival benefit could only be demonstrated in comparison with a control group only treated symptomatically. Because of several reports on major local toxicity of i.a.
FUdR treatment (i.e. chemical
hepatitis and biliary
sclerosis) several other effective i.a.
5-FU regimens have been developed. A randomized study has demonstrated superiority of i.a.
5-FU versus i.a.
FUdR. In comparison with systemic treatment, superiority has only been demonstrated in patients with an intrahepatic
tumor burden of < 25%. Publications about regional treatment of patients with breast,
gastric cancer or
carcinoid liver
metastases are rare. Despite the high response rates reported, the benefit of arterial
chemotherapy remains questionable. Overall, local long-term
chemotherapy cannot be recommended outside of studies as a primary treatment. However, extensive experience and new drugs support the idea of conducting further regional studies.