Colorectal Cancer Spread to Liver: No Longer a Death Sentence
Dec. 29, 1999 (Atlanta) -- A new way to administer chemotherapy greatly improves survival among colorectal cancer patients whose disease has spread to the liver. If the liver tumors can be removed with surgery, a major study shows implantation of a chemotherapy pump greatly improves overall survival and prevents new spread of cancer to the liver.
Every year, about 129,000 U.S. residents are told they have cancer of the colon or the rectum. More than half of these patients have the disease spread, or metastasize, to their liver, but often the disease spreads no further. Until very recently, this didn't make much difference: when the liver tumors were inoperable, or unable to be removed, no more than one in five patients responded to chemotherapy.
These odds have changed dramatically in recent years due to an important observation. Tumors that spread to the liver get most of their blood from the hepatic artery, while normal liver cells obtain most of their blood through a different path, the portal vein. Several research teams, including Nancy Kemeny, MD, and colleagues at Memorial Sloan-Kettering Cancer Center in New York, have shown that local infusion of chemotherapy through the hepatic artery via an implanted pump improves the chemotherapy response rate to 42% to 62% in patients whose liver tumors could not be removed.
Impressed by these findings, Kemeny and co-workers wondered whether the technique would work even better in colorectal cancer patients whose liver tumors were completely removed by surgery. Even this group of patients currently faces a relatively grim prognosis: a 65% two-year survival rate. The researchers therefore set up a study that compared patients treated after liver-tumor removal with both local chemotherapy (via the pump) and traditional chemotherapy to similar patients treated with traditional chemotherapy alone.
"We saw a significant increase in survival and a significant decrease in recurrence," Kemeny tells WebMD. "At two years, 86% of patients who got the pump were alive versus 72% without the pump." She suggests that the unusually high survival rate among the patients receiving only traditional therapy probably was due to the highly aggressive surgical approach to seeking and removing the cancer at her institution.
At the time the study was designed, only 25% of patients with this type of cancer survived for two years; thus the study was designed to end at two years. The results were dramatic: after two years, 90% of the patients in the combined therapy group had no recurrence, compared to 60% of the patients in the group receiving the single therapy. The single-therapy patients were almost 2.5 times more likely to die after two years than combined therapy patients.
In an interview to provide objective comment, William R. Dinwoodie, MD, tells WebMD that the pump technique holds promise, but that this data is still preliminary. "The benefits aren't as clear at five years. I'd be interested in what is going to happen with the overall survival then. But yes, indeed, at two years it seems very promising," says Dinwoodie, a clinical oncologist at the H. Lee Moffitt Cancer Center in Tampa, Fla.