Introduction Peri-operative chemotherapy confers a 3-year progression free survival advantage for patients with colorectal liver metastases. Degree of post-chemotherapy tumour necrosis is associated with disease free survival. However, systemic neoadjuvant chemotherapy is associated with pathological damage to hepatic parenchyma, increasing perioperative morbidity and mortality. Irinotecan eluting beads (DEBIRI-TACE) are delivered to tumour intra-arterially, where they provide controlled & sustained delivery of Irinotecan directly to tumour, maximising response and reducing systemic exposure. This study aimed to examine the feasibility and safety of a single neoadjuvant bead embolisation 1-month before hepatectomy.
Methods Patients with easily resectable colorectal liver metastases received DEBIRI-TACE 1 month before surgery. Primary end-point was tumour resectability, Secondary end points included pathological tumour response and safety.
Results TACE attempted in 49 patients and was successful in 40. Reasons for failed TACE included arterial abnormality (n=2), progressive disease (n=2), bilobar disease (n=2), hepatoma (n=1), allergy to contrast (n=1) and concomitant infection (n=1). There was one post-TACE liver abscess (3%), and 1 post TACE pancreatitis (3%) (recognised complications). 38 patients have undergone hepatic resection so far, with R0 resection rate of 100% and no significant post-hepatectomy morbidity. Thirty day post-operative mortality was 7.6% (n=2), with neither death related to TACE (one intraoperative pneumomediastinum, one MODS after aspiration pneumonia). Complete pathological response (no viable tumour) was demonstrated in 15% of lesions, major response in 55% and minor response in 30%.
Conclusion Neoadjuvant DEBIRI TACE for resectable colorectal liver metastasis is safe and is not associated with increased post-hepatectomy morbidity. A single treatment with DEBIRI-TACE resulted in pathological response of tumour similar to that seen after systemic treatment, which may translate to improved progression free survival.
Competing interests None declared.
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