Gastric cancer is associated with high mortality. Although the liver is a common site of metastases in this tumor, the experience with liver-directed therapies is limited.
Methods
We report a single-center experience involving four patients with liver metastases from gastric cancer treated by hepatic arterial infusion (HAI). In addition, we performed a search for reports on HAI in gastric cancer metastatic to the liver and used the studies with data on survival of individual patients for a pooled analysis.
Results
Among three valuable patients, one had a complete response, one had stable disease and one had progressive disease. The patient with complete response is still alive 41 months after the diagnosis of liver metastases, while the other patients died 6, 22 and 31 months after the diagnosis. Objective responses were observed in 48% of the 25 patients in the pooled analysis. Objective response and limited hepatic involvement were independent predictors of survival in these patients.
Conclusions
Although isolated liver involvement in metastatic gastric cancer is rare, HAI seems to be similarly effective in these patients as in patients with liver metastases from colorectal cancer. The prognosis is significantly better in gastric cancer patients who have limited hepatic involvement and attain an objective response after HAI.
LeviF., LucchiniF., NegriE., BoyleP., La VecchiaC.: Cancer mortality in Europe, 1990-1994, and an overview of trends from 1955 to 1994. Eur J Cancer, 35: 1477–1516, 1999.
2.
GreenleeR.T., Hill-HarmonM.B., MurrayT., ThunM.: Cancer statistics 2001. CA Cancer J Clin, 51: 15–36, 2001.
3.
KakejiY., MaeharaY., TomodaM., KabashimaA., OhmoriM., OdaS., OhnoS., SugimachiK.: Long term survival of patients with stage IV gastric carcinoma. Cancer, 82: 2307–2311, 1998.
4.
FujisakiS., TornitaR., NezuT., KimizukaK., ParkE., FukuzawaM.: Prognostic studies on gastric cancer with concomitant liver metastases. Hepatogastroenterology, 48: 892–894, 2001.
5.
StehlinJ.S., de IpolyiP.D., GreeffP.J., McGaffC.J., DavisB.R., McNaryL.: Treatment of cancer of the liver. Twenty years’ experience with infusion and resection in 414 patients. Ann Surg, 208: 23–35, 1988.
6.
KumadaT., AraiY., ItohK., TakayasuY., NakamuraK., AriyoshiY., TajimaK.: Phase II study of combined administration of 5-fluorouracil, epirubicin and mitomycin-C by hepatic artery infusion in patients with liver metastases of gastric cancer. Oncology, 57: 216–223, 1999.
7.
VenookA.P., WarrenR.S.: Regional chemotherapy approaches for primary and metastatic liver tumors. Surg Oncol Clin N Amer, 5: 411–427, 1996.
8.
Meta-Analysis Group in Cancer:Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer. J Natl Cancer Inst, 88: 252–258, 1996.
9.
EarlamS., GloverC., DaviesM., FordyC., Allen-MershT.G.: Effect of regional and systemic fluorinated pyrimidine chemotherapy on quality of life in colorectal liver metastasis patients. J Clin Oncol, 15: 2022–2029, 1997.
10.
FrakerD.L., SoulenM.: Regional therapy of hepatic metastases. Hem Oncol Clin N Am, 16: 947–967, 2002.
11.
BengtssonG., CarlssonG., HafstromL., JonssonP.E.: Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg, 141: 586–589, 1981.
12.
MillerA.B., HoogstratenB., StaquetM., WinklerA.: Reporting results of cancer treatment. Cancer, 47: 207–214, 1981.
13.
KanoT., KumashiroR., AbeY., NotsukaT., TamataR., InokuchiK.: Combination of hepatic arterial infusion and systemic chemotherapy for gastric cancer with synchronous hepatic metastases. Jpn J Surg, 14: 23–29, 1984.
14.
IwahashiM., TanimuraH., NakamoriM., NagaiY., HirabayashiN., UedaK., MatsudaK., TsunodaT., YamaueH.: Clinical evaluation of hepatic arterial infusion of low dose-CDDP and 5FU with hyperthermotherapy: a preliminary study for liver metastases from esophageal and gastric cancer. Hepatogastroenterology, 46: 2504–2510, 1999.
15.
FujimotoS., ShresthaR.D., KasanukiJ., KokubunM., ItchikiN., MiyazakiA., OhtaM., OkuiK.: Gastric cancer with synchronous unresectable hepatic metastases and a positive response to chemotherapy. Report of two cases. Jpn J Surg, 17: 307–311, 1987.
16.
MoriyaA., HyodoI., NishinaT., ImaokaH., ImagawaA., DoiT., EndoH., TanimizuM., TajiriH.: Extensive liver metastasis of gastric cancer effectively treated by hepatic arterial infusion of 5-fluorouracil/cisplatin. Gastric Cancer, 3: 110–115, 2000.
17.
OkanoK., MaebaT., IshimuraK., KarasawaY., GodaF., WakabayashiH., UsukiH., MaetaH.: Hepatic resection for metastatic tumors from gastric cancer. Ann Surg, 235: 86–91, 2002.
18.
RafiqueM., AdachiW., KajikawaS., KobayashiM., KoikeS., KurodaT.: Management of gastric cancer patients with synchronous hepatic metastasis: a retrospective study. Hepatogastroenterology, 42: 666–671, 1995.
19.
AraiY., EndoT., SoneY., TohyamaN., InabaY., KohnoS., AriyoshiY., KidoC.: Management of patients with unresectable liver metastases from colorectal and gastric cancer employing an implantable port system. Cancer Chemother Pharmacol, 31: S99–S102, 1992.
20.
YonemuraY., MatukiN., SakumaH., KatayamaK., SawaT., FujimuraT., OhyamaS., MiwaK., MiyazakiI., TanakaM., SasakiT.: Effect of intra-hepatoarterial infusion of MMC and CDDP for gastric cancer patients with liver metastases. Surg Today, 22: 253–259, 1992.
21.
EliasD., Cavalcanti de AlbuquerqueA., EggenspielerP., PlaudB., DucreuxM., SpielmannM., TheodoreC., BonvalotS., LasserP.: Resection of liver metastases from a noncolorectal primary: indications and results based on 147 monocentric patients. J Am Coll Surg, 187: 487–493, 1998.
MiyazakiM., ItohJ., NakagawaK., AmbiruS., ShimizuH., TogawaA., ShiobaraM., OhtsukaM., SasadaK., ShimizuY., YoshiokaS., NakajimaN., SuwaT., KimuraF.: Hepatic resection of liver metastases from gastric carcinoma. Am J Gastroenterol, 92: 490–493, 1997.
24.
AmbiruS., MiyazakiM., ItoH., NakagawaK., ShimizuH., YoshidomeH., ShimizuY., NakajimaN.: Benefits and limits of hepatic resection for gastric metastases. Am J Surg, 181: 279–283, 2001.
25.
TaniguchiH., TakahashiT., SawaiK., YamaguchiT., HagiwaraA., KitamuraK., HoshimaM., MasuyamaM., MugitaniT., TakadaA., YamaguchiA.: Comparison in survival between hepatic metastases of gastric and colorectal cancers. Hepatogastroenterology, 44: 897–900, 1997.
26.
ImamuraH., MatsuyamaY., ShimadaR., KubotaM., NakayamaA., KobayashiA., KitamuraH., IkegamiT., MiyagawaS., KawasakiS.: A study of factors influencing prognosis after resection of hepatic metastases from colorectal and gastric carcinoma. Am J Gastroenterol, 96: 3178–3184, 2001.
27.
YagiY., SehimoA., KameokaS.: Prognostic factors in stage IV gastric cancer: univariate and multivariate analyses. Gastric Cancer, 3: 71–80, 2000.
28.
ChangA.E., SchneiderP.D., SugarbakerP.H., SimpsonC., CulnaneM., SteinbergS.M.: A prospective randomized trial of regional versus systemic continuous 5-fluorodeoxyuridine chemotherapy in the treatment of colorectal liver metastases. Ann Surg, 206: 685–693, 1987.
29.
RougierP., LaplancheA., HuguierM., HayJ.M., OllivierJ.M., EscatJ., SalmonR., JulienM., Roullet AudyJ.C., GallotD., GouziJ.L., PaillerJ.L., ElisaD., LacaineF., RoosS., RotmanN., LuboinskiM., LasserP.: Hepatic arterial infusion of floxuridine in patients with liver metastases from colorectal carcinoma: Long-term results of a prospective randomized trial. J Clin Oncol, 10: 1112–1118, 1992.
30.
HohnD.C., StaggR.J., FriedmanM.A., HanniganJ.F., RaynerA., IgnoffoR.J., AcordP., LewisB.J.: A randomized trial of continuous intravenous versus hepatic intraarterial floxuridine in patients with colorectal cancer metastatic to the liver: the Northern California Oncology Group trial. J Clin Oncol, 7: 1646–1654, 1989.
31.
KemenyN., DalyJ., ReichmanB., GellerN., BotetJ., OdermanP.: Intrahepatic or systemic infusion of fluorodeoxyuridine in patients with liver metastases from colorectal carcinoma. Ann Intern Med, 107: 459–465, 1987.
32.
Allen-MershT.G., EarlamS., FordyC., AbramsK., HoughtonJ.: Quality of life and survival with continuous hepatic-artery floxuridine infusion for colorectal liver metastases. Lancet, 344: 1255–1260, 1994.
33.
MaetaM., KogaS., ShimizuN., HamazoeR., MurakamiA., IshiguroM., SawadaT.: Intra-hepato-arterial chemotherapy with CDDP and 5-FU for metastases to the liver from colorectal and gastric cancers. Eur J Cancer Clin Oncol, 24: 1199–1203, 1988.
34.
DharD.K., KubotaH., YamanoiA., OnoT., YoshimuraH., OhnoS., TachibanaM., KohnoH., NagasueN.: Selective approaches to gastric cancer patients with liver metastases: role of liver-directed chemotherapy. Dig Liver Dis, 33: 614–618, 2001.
35.
KuriharaN., KubotaT., FurukawaT., WatanabeM., OtaniY., KumaiK., KitajimaM.: Chemosensitivity testing of primary tumor cells from gastric cancer patients with liver metastasis can identify effective antitumor drugs. Anticancer Res, 19: 5155–5158, 1999.
36.
KikuchiS., TsukamotoH., MienoH., SatoK., KobayashiN., ShimaoH., SakakibaraY., HikiY., KakitaA.: Results of resection of gastric cancer with distant metastases. Hepatogastroenterology, 45: 592–596, 1998.
37.
TarazovP.G.: Transcatheter therapy of gastric cancer metastatic to the liver: preliminary results. J Gastroenterol, 35: 907–911, 2000.
38.
OkuyamaK., IsonoK., JuanI.K., OnodaS., OchiaiT., YamamotoY., KoideY., SatohH.: Evaluation of treatment for gastric cancer with liver metastasis. Cancer, 55: 2498–2505, 1985.
39.
KuniedaK., SajiS., SugiyamaY., OsadaS., SanoJ., NagaoN., TakahashiT., TakagiY., AraiY.: Evaluation of treatment with synchronous hepatic metastases from gastric cancer with special reference to long-term survivors. Surg Today, 32: 587–593, 2002.
40.
KimotoT., YamanoiA., UchidaM., MakinoY., OnoT., KoiinoH., NagasueN.: Repeated hepatic dearterialization for unresectable carcinomas of the liver: report of a 10-year experience. Surg Today, 31: 984–990, 2001.
41.
HamazoeR., MurakamiA., HirookaY., MaetaM., KaibaraN.: A phase II pilot study of the combined application of hyperthermia and intra-hepato-arterial chemotherapy using cisplatinum and 5-fluorouracil. J Surg Oncol, 48: 127–132, 1991.
