Hepatic Recurrence Rate Based on Extent of Adjuvant Floxuridine Exposure After Resection of Colorectal Liver Metastases.

Abstract

Hepatic artery infusion (HAI) chemotherapy improves hepatic recurrence rates and survival for patients with colorectal liver metastases (CRLM) in the adjuvant setting. Dose reductions of HAI floxuridine (FUDR) are common due to hepatotoxicity. The impact of these dose adjustments on patient outcomes is unclear. This study retrospectively analyzed patients who underwent adjuvant HAI pump placement for CRLM between January 2000 and October 2017. The study enrolled only patients intended to receive six cycles of FUDR. Hepatic recurrence and overall survival (OS) were correlated with the number of FUDR cycles and dose density, defined as the actual FUDR dose received divided by the expected total during six cycles. The study identified 344 patients who met the inclusion criteria. Of these 344 patients, 173 received up to four cycles of FUDR and 171 received > 4 cycles. The median dose density was 0.42 (range, 0.17-1.13). Competing risk analysis of the two groups showed no difference in risk for liver recurrence (p = 0.357). Neither the cycles of FUDR received (hazard ratio [HR], 0.93; p = 0.237) nor the FUDR dose density (HR, 1.26; p = 0.631) was associated with hepatic recurrence in the univariable analysis. Dose density was not associated with improved OS (HR, 1.35; p = 0.486), although in the multivariable analysis, increased FUDR cycles were associated with improved OS (HR, 0.86; p = 0.005). In adjuvant HAI therapy for CRLM, neither the number of FUDR cycles nor the dose density of FUDR is associated with hepatic recurrence.