Adjuvant Hepatic Arterial Infusion Chemotherapy for Resectable Colorectal Liver Metastases

Resection of colorectal liver metastases (CRLMs) is the only potentially curative treatment option, with a 10-year survival of approximately 25%. However, at least two-thirds of patients develop recurrent disease after curative-intent resection of CRLM, which in up to 50% of patients is confined to the liver. Several randomized controlled trials (RCT) have failed to prove that adjuvant systemic chemotherapy increases overall survival (OS) after curative intent resection of CRLM. Hepatic arterial infusion chemotherapy (HAIC) in the adjuvant setting is an alternative strategy that aims to prevent or delay intrahepatic recurrence. This chapter is a review of the literature for adjuvant HAIC after resection of CRLM. Several RCTs demonstrated superior (hepatic) disease-free survival for adjuvant HAIC with floxuridine after resection of CRLM. Only one RCT demonstrated superior 2-year OS. The authors recommend that adjuvant HAIC should be limited to centers with extensive multidisciplinary experience and/or used exclusively in clinical trials. Patients with a high risk of intrahepatic recurrence are most likely to benefit from adjuvant HAIC, although it is unclear how to best select these patients. Further, no consensus exists on the benefit, type, duration, and dosage of concurrent systemic chemotherapy in patients with resected CRLM. Adjuvant strategies vary widely within and across countries. The available evidence for adjuvant HAIC with floxuridine should be validated in well-designed and adequately powered RCTs.