Different Response to Intraarterial Hepatic Chemotherapy (IAHC) between Right and Left Lobe in Case of Separated Origin of Right and Left Hepatic Artery: Can Arterial Ischemia Determine a Major Therapeutic Efficacy?
Purpose: IAHC has demonstrated better response rate than systemic intravenous chemotherapy, particularly in case of liver metastases from colorectal cancer. Our aim was to evaluate different response to IAHC between right and left hepatic lobe, in presence of anatomic variant with separated origin of Right Hepatic Artery (RHA) and Left Hepatic Artery (LHA), in patients affected by liver metastases from colorectal cancer.
Methods and Materials: With a transaxillary approach, under US and fluoroscopic guidance, a 5.8F permanent catheter was percutaneosly placed in 27 RHA or 3 LHA, considering distribution of metastases, caliber of RHA and LHA and dimension of the 2 hepatic lobes; the proximal part of the controlateral hepatic artery was embolized with Gianturco microcoils to obtain a distal vascularization through collateral vessels arising from the catheterized artery. Different response of the hepatic lobes, submitted to catheterization (group A) or embolization (group B), was analyzed with a contrast-enhanced spiral CT, comparing the addition of the areas of the 2 lesions of major caliber for each lobe before and after 3 cycles of IAHC. IAHC was based on continuous infusion of fluorodeoxiuridine (FUDR), for 14 days every 28 days, administered through an external infusion pump.
Results: A better response of group B than group A was found in 54.5% of the cases, while better response of group A in 18.1% of the cases. Similar response was found in 27.2% of the cases.
Conclusion: From this preliminary study, arterial ischemia can be considered effective and more probably important than local chemotheraupeutic concentration in the treatment of liver metastases from colorectal cancer. Therefore, in case of anatomic variant, with separated origin of right and left hepatic artery, it could be paradoxically preferable to embolize the hepatic lobe with a major number of metastases and to place the catheter for IAHC infusion in the controlateral lobe.