Combination of hepatic arterial infusion and systemic chemotherapy for gastric cancer with synchronous hepatic metastases

Hepatic Arterial Infusion Chemotherapy in Gastric Cancer: A Report of Four Cases and Analysis of the Literature

Aims and background

Gastric cancer is associated with high mortality. Although the liver is a common site of metastases in this tumor, the experience with liver-directed therapies is limited.

Methods

We report a single-center experience involving four patients with liver metastases from gastric cancer treated by hepatic arterial infusion (HAI). In addition, we performed a search for reports on HAI in gastric cancer metastatic to the liver and used the studies with data on survival of individual patients for a pooled analysis.

Results

Among three valuable patients, one had a complete response, one had stable disease and one had progressive disease. The patient with complete response is still alive 41 months after the diagnosis of liver metastases, while the other patients died 6, 22 and 31 months after the diagnosis. Objective responses were observed in 48% of the 25 patients in the pooled analysis. Objective response and limited hepatic involvement were independent predictors of survival in these patients.

Conclusions

Although isolated liver involvement in metastatic gastric cancer is rare, HAI seems to be similarly effective in these patients as in patients with liver metastases from colorectal cancer. The prognosis is significantly better in gastric cancer patients who have limited hepatic involvement and attain an objective response after HAI.

Gastric carcinoma with synchronous liver metastases: palliative gastrectomy or not?

During a 6 year period, 38 patients with gastric cancer presented with synchronous liver metastases and 25 underwent gastric resection. Forty per cent of the operated patients presented with complications, whereas most of the non-operated patients presented with pain or an abdominal mass. Eight patients (32%) developed postoperative morbidity, five of whom died (20%). The median duration of hospital stay for those surviving surgery was 33 days. In the non-operated group 61% died while in hospital and the median duration of hospital stay was 28 days. The respective median survival time and duration of home stay were 13 and 9 weeks for the operated patients and 6 and 3 weeks for the non-operated patients. The difference of the duration of home stay between the two groups of patients was statistically insignificant. There was also no significant relief of pain after surgery. Univariate analyses of the influence on survival time of operation among 13 other factors showed that only bilirubin was significant. We conclude that gastrectomy neither prolongs life nor improves the quality of survival in patients with gastric cancer and discontiguous liver metastases. However, gastrectomy may be beneficial in selected patients presenting with potentially lethal complications such as bleeding and obstruction.