Intervention Review

Hepatic artery adjuvant chemotherapy for patients having resection or ablation of colorectal cancer metastatic to the liver

  1. Richard L Nelson1,*,
  2. Sally Freels2

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 30 JUL 2006

DOI: 10.1002/14651858.CD003770.pub3


How to Cite

Nelson RL, Freels S. Hepatic artery adjuvant chemotherapy for patients having resection or ablation of colorectal cancer metastatic to the liver. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003770. DOI: 10.1002/14651858.CD003770.pub3.

Author Information

  1. 1

    Northern General Hospital, Department of General Surgery, Sheffield, Yorkshire, UK

  2. 2

    University of Illinois School of Public Health, Epidemiology/Biometry, Chicago, Illinois, USA

*Richard L Nelson, Department of General Surgery, Northern General Hospital, Herries Road, Sheffield, Yorkshire, S5 7AU, UK. altohorn@btinternet.com. Rick.Nelson@sth.nhs.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 18 OCT 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト

Background

Colorectal cancer metastatic to the liver, when technically feasible, is resected with a moderate chance of cure. The most common site of failure after resection is within the remaining liver. With this pattern of clinical failure in mind and in order to enhance survival, chemotherapy has been delivered directly to the liver post resection via the hepatic artery.

Objectives

To assess the effect of post hepatic resection hepatic artery chemotherapy on overall survival. Secondary objectives include adverse events related to the chemotherapy, the risk of intra-hepatic tumour recurrence and tumour free survival.

Search methods

Randomised trials were sought in MEDLINE; the Cochrane Central Register of Controlled Trials; the Cochrane Hepato-Biliary Group Controlled Trials Register; and through contact of trial authors and reference lists using key words: Colorectal, cancer, hepatic metastases, hepatic artery, chemotherapy.
Searches were performed in December, 2008.

Selection criteria

Trials in which patients having resection of colorectal cancer metastatic to the liver were randomised either to hepatic artery chemotherapy or any alternative treatment.

Data collection and analysis

Survival data were obtained principally from abstraction from survival curves in published studies using the method of Parmar. A study specific log hazard ratio and then combined effect log hazard ratio were calculated, as well as a combined Kaplan-Meier survival probability curve.

Main results

Seven randomised trials addressed this issue, encompassing 592 patients. No significant advantage was found in the meta-analysis for hepatic artery chemotherapy measuring overall survival and calculating survival based upon "intention to treat" (lnHR = 0.0848; favouring the control group, 95% confidence interval = -0.1189 to 0.2885, or a Hazard Ratio of 1.089, an 8.9% survival advantage for the control group, 95% CI of the HR = 0.887 - 1.334). Adverse events related to the hepatic artery therapy were common, including five therapy related deaths. Intra-hepatic recurrence was more frequent in the control group (97 patients versus 43 in the HAI group), though denominators are not reported, and additional outcomes could not be subjected to a combined analysis.

Authors' conclusions

Though recurrence in the remaining liver happened less in the hepatic artery chemotherapy group, overall survival was not improved, and even favoured the control group, though not significantly. This added intervention cannot be recommended at this time.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト

Chemotherapy delivered via the hepatic artery following surgical resection of liver metastases arising from colorectal cancer does not improve survival.

Patients who die of colorectal cancer usually die from, or at least with, liver metastases. On the other hand, isolated liver metastases can, on occasion, be resected with a chance of cure, if metastatic disease is not present elsewhere. After liver resection is performed for colorectal cancer metastases, the most common site of treatment failure is in the remaining liver. For that reason it has been proposed that chemotherapy be given in the hepatic artery after surgery to treat microscopic disease in the remaining liver.
This systematic review assesses the randomised trials that have addressed the effective ness of this additional chemotherapy. Seven studies have been published in this field, and the combined analysis shows that survival is not improved by hepatic artery chemotherapy.

 

アブストラクト

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト

大腸癌の肝転移切除またアブレーションが施行された患者に対する肝動脈補助化学療法

背景

大腸癌の肝転移は技術的に実施可能な場合は切除され、中等度の治癒の可能性がある。切開後に最もよくみられる再発部位は、残存肝臓内である。このような臨床的な再発パターンに留意し、生存を向上させるために、切除後に肝動脈から直接、肝臓に化学療法が行われている。

目的

肝切除後の肝動脈内化学療法が全生存期間に及ぼす効果を評価する。副次的目的は、化学療法に関連した有害事象、肝臓内の腫瘍再発リスク、無腫瘍生存期間であった。

検索戦略

キーワード「Colorectal」、「cancer」、「hepatic metastases」、「hepatic artery」、「chemotherapy」を用いて、MEDLINE、Cochrane Central Register of Controlled Trials、Cochrane Hepato-Biliary Group Controlled Trials Registerを検索し、試験著者に問い合わせ、参考文献リストを検索してランダム化試験を探した。2008年12月に検索を行った。

選択基準

大腸癌の肝転移切除が施行された患者を肝動脈内化学療法または代替療法のいずれかにランダム化した試験。

データ収集と分析

生存データはParmar法を用いて、発表済みの研究の生存曲線から主に抽出して取得した。研究に特異的な対数ハザード比、次に統合した効果の対数ハザード比を計算し、統合したカプラン・マイアー生存確率曲線を算出した。

主な結果

この課題は、592例の患者を対象に7件のランダム化試験で検討されていた。ITTに基づき全生存期間を測定し、生存率を計算した結果、メタアナリシスで肝動脈内化学療法を支持する有意な利益は認められなかった(対数HR=0.0848、コントロール群に有利、95%信頼区間=-0.1189~0.2885、またはハザード比1.089、コントロール群において8.9%生存率が有利、HRの95%CI=0.887~1.334)。肝動脈内化学療法に関係した有害事象は高頻度であり、治療関連死が5件含まれた。肝臓内の再発はコントロール群の方が頻度が高かったが(97例に対してHAI群では43例)、分母は報告されていなかった。その後追加されたアウトカムは統合解析に組み入れることはできなかった。

著者の結論

残存肝臓内の再発は肝動脈内化学療法群の方が少なかったものの、全生存期間は改善されず、有意ではないがコントロール群の方が好ましい結果さえもあった。現時点でこの介入を追加することは推奨できない。

訳注

監  訳: 柴田 実,2010.2.10

実施組織: 厚生労働省委託事業によりMindsが実施した。

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