HPB
Kavin Sugumar, MD (he/him/his)
Resident
Department of Surgery, Tulane University School of Medicine, Louisiana, United States
Kavin Sugumar, MD (he/him/his)
Resident
Department of Surgery, Tulane University School of Medicine, Louisiana, United States
Kavin Sugumar, MD (he/him/his)
Resident
Department of Surgery, Tulane University School of Medicine, Louisiana, United States
Henry Stizel, BS
Medical Student
2. Case Western Reserve University School of Medicine, Cleveland, OH, United States
Victoria Wu, BA
Medical Student
2. Case Western Reserve University School of Medicine, Cleveland, OH, United States
David Bajor, MD
Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
Sakti Chakrabarti, MD
Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
Madison Conces, MD
Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
Lauren Henke, MD
Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
Melissa Lumish, MD
Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
Amit Mahipal, MD
Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
Amr Mohamed, MD
Assistant professor
Department of Medicine, Division of Hematology/Oncology, University Hospitals Seidman Cancer Center, case Western Reserve University, Cleveland, OH, United States
Jordan M. Winter, MD, MBA
Professor
4. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
Jeffrey M. Hardacre, MD
Professor
4. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
John B. Ammori, MD
Associate Professor
4. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
Jennifer Selfridge, MD, PhD
Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
Lee M. Ocuin, MD
Associate Professor
4. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
Treatment of unresectable colorectal liver metastases (UCRLM) includes locoregional therapy in conjunction with systemic therapy. A comprehensive analysis capturing long-term outcomes of these treatment options has not been performed.
Methods: A systematic review and meta-analysis was performed to calculate pooled long-term outcomes of hepatic artery infusion with systemic chemotherapy (HAI-S), transarterial chemoembolization (TACE), transarterial radioembolization (TARE), FOLFOX, FOLFIRI, and FOLFOXIRI. Primary outcomes included overall survival (OS) and progression-free survival (PFS). Secondary outcomes were rate of conversion to resection (CTR) and response rate (RR).
Results:
A total of 32, 27, 33, and 14 publications were included in the HAI-S, TACE, TARE, and chemotherapy arms with 1691, 2415, 3534, and 1712 patients respectively. The 6/12/24/36-month OS estimates for HAI-S, TACE, TARE, FOLFOX/FOLFIRI, and FOLFOXIRI were 97%/80%/54%/35%, 89%/67%/34%/14%, 73%/47%/24%/16%, 96%/83%/53%/36%, and 96%/93%/72%/55%. Similarly, the 6/12/24/36-month PFS estimates were 74%/44%/19%/14%, 56%/22%/12%/4%, 56%/25%/12%/8%, 69%/30%/12%/7%, and 88%/55%/18%/11%. The corresponding CTR rates was 31%, 9%, 1%, 35%, and 53% respectively. The corresponding RR were 49%, 42%, 32%, 50%, and 80% respectively. Most of the chemotherapy studies included first-line therapy and liver-only metastases, whereas most HAI-S studies included pre-treated patients. On subgroup analysis of patients in the first-line setting with liver-only metastases, the HAI-S arm had comparable outcomes to patients treated with FOLFOXIRI, and outperformed doublet chemotherapy regimens (Figure). Subgroup analysis was not possible for TARE and TACE arms due to very small number of corresponding studies.
Conclusions:
There exist multiple treatment options for patients with UCRLM. Patients treated with TACE or TARE appear to have generally poor OS, PFS, and low CTR compared to HAI-S. HAI-S is an effective treatment for UCRLM, with promising outcome in both pre-treated patients and first-line settings.