Postoperative prophylactic hepatic arterial infusion chemotherapy for stage III colorectal cancer: a retrospective study

Intra-arterial chemotherapy improved survival of stage 2-3 gallbladder cancer after curative resection

Objective

To investigate the impact of postresection intra-arterial chemotherapy (IAC) on prognosis of stage 2–3 gallbladder cancer (GBC) after curative resection.

Methods

Between May 2010 and August 2014, 76 cases of GBC accepted curative surgery in our center and were pathologically staged as 2–3. After resection, 37 underwent 4 courses of intravenous chemotherapy (IVC) following 2 courses of IAC (ART group), and 39 received 6 courses of IVC (SYS group). Both the IAC and IVC regimens consisted of oxaliplatin (85 mg/m²) on day 1 and gemcitabine (800 mg/m²) on day 1 and day 8. Chemotherapy-related complications, disease-free survival (DFS), overall survival (OS), and hepatic metastases-free survival (HMFS) were retrospectively analyzed.

Results

Patient characteristics and chemotherapy complications did not differ between the two groups. There was no significant difference in 3-year DFS of the two groups (p=0.0822, HR=0.6270; 95% CI, 0.3627 to 1.0838). The ART group had significantly higher 3-year OS (p=0.0378, HR=0.5460; 95% CI, 0.3025 to 0.9856) and 3-year HMFS (p=0.0414, HR=0.5187; 95% CI, 0.2706 to 0.9940) than the SYS group.

Conclusions

IAC could effectively and safely decrease postresection hepatic metastases and improve 3-year HMFS and OS of stage 2–3 GBC.

Postoperative hepatic arterial infusion chemotherapy improved survival of pancreatic cancer after radical pancreatectomy: a retrospective study

Objective

To determine the effect of postoperative hepatic arterial infusion chemotherapy (HAIC) on long-term survival of patients with pancreatic cancer (PC) after radical pancreatectomy.

Methods

A total of 87 patients with PC underwent radical pancreatectomy in the First People's Hospital affiliated to Huzhou Normal College between June 2008 and May 2013. Among these patients, after surgery, 43 received two sessions of HAIC followed by four sessions of systemic chemotherapy (HAIC group), while 44 received six sessions of systemic chemotherapy alone (control group). Both the HAIC and systemic chemotherapy regimen included 5-fluorouracil (1,000 mg/m²) as a 5-h infusion on day 1, and gemcitabine (800 mg/m²) as an over 30-min infusion on days 1 and 8. The toxicity, complication, and long-term survival were retrospectively compared.

Results

No significant difference in patient characteristics between the two groups was found. No chemotherapy-related deaths were recorded, and no significant difference in toxicities was observed between the two groups. The 5-year disease-free survival probability did not differ between the two groups (P=0.2029, hazard ratio for recurrence=0.7561; 95% CI=0.4768-1.1989, by the log-rank test). The HAIC group had significantly higher 5-year overall survival probability (P=0.0288, hazard ratio for death=0.6059; 95% CI=0.3734-0.9832, by the log-rank test) and higher 5-year hepatic metastases-free survival probability (P=0.0321, hazard ratio for hepatic metastases=0.5006; 95% CI=0.2546-0.9843, by the log-rank test) than the control group.

Conclusions

Postoperative HAIC has the potential to prevent hepatic metastases and increase long-term survival probability of patients with PC after radical pancreatectomy.

How and when adjuvant treatment should be intensified in stage III colorectal cancers?

The adjuvant chemotherapy (FOLFOX) represents the standard of care in stage III colon cancer with some exceptions in old patients. Adjuvant treatment must also be discussed in high-risk stage II colon cancer. However, 40-50% of patients develop disease recurrence after curative R0 surgical resection. The liver was the most common site of recurrence followed by peritoneum. Although adjuvant chemotherapy improved disease-free survival and overall survival, 5-year overall survival remains less than 55% in stage III colon cancer. Different strategies could be adopted to escalate the standard adjuvant chemotherapy in these patients going from aggressive intravenous chemotherapy, hepatic arterial infusion chemotherapy, hyperthermic intraperitoneal chemotherapy to adding targeted therapies or immunotherapies. We reported in this review the published and ongoing trials evaluating these treatment modalities in colon cancer.