Systemic Infusional Chemotherapy for Liver Metastasis: An Improved Schedule for 5-Fluorouracil

Abstract

Regional chemotherapy, and particularly hepatic arterial chemotherapy, has had a resurgence of interest in the recent past because of the development of improved technology in the form of the implanted infusion pump. The history of this form of chemotherapy, however, over the past 2 decades has consistently demonstrated response rates which are superior to standard systemic chemotherapy and in fact hepatic arterial chemotherapy is effective in 25%–60% of patients not responding to the standard systemic delivery. The rationale for regional delivery relates to maximizing the dose delivery to the tumor and because of hepatic extraction minimizing host toxicity in spite of the maximal doses. However, in addition to the regional delivery of drug, there is another important distinction from standard chemotherapy, namely the infusion schedule.