Extrahepatic biliary stenoses after hepatic arterial infusion (HAI) of floxuridine (FUdR) for liver metastases from colorectal cancer

摘要: Hepatic arterial infusion of floxuridine is an effective treatment for unresectable hepatic metastases from colorectal cancer. Despite its pharmacological advantage higher tumor drug concentration with minimal systemic toxicity, characterized by regional including hepatobiliary damage resembling idiopathic sclerosing cholangitis (5-29% treated cases). Unlike previous reports describing biliary both intrahepatic and extrahepatic ducts, a case series stenosis after herein described. Between September 1993 February 1999, 54 patients received intraarterial chemotherapy based on continuous (dose escalation 0.15-0.30 mg/kg/day 14 days every 28 days) plus dexamethasone mg. Twenty-seven underwent laparotomy to implant the catheter into artery, other 27 receiving percutaneous artery through transaxillary access. Five (9.2%) developed toxicity jaundice (3 cases), alterations liver function tests radiological features tract abnormalities. They 9 19 cycles (mean 14.5 +/- 6.3 cycles) total delivered dose ranging 20.3 41.02 mg/kg (mean: 31.4 13.5 mg/kg). Extrahepatic sclerosis was discovered computed tomography scan ultrasound, followed endoscopic retrograde cholangiopancreatography and/or cholangiography in 3 cases. Radiological findings included common duct complete obstruction 1 case, 2 cases, bile ducts dilation without well-recognized case. Two were sequentially drainage balloon while patient had transpapillary prosthesis placed. Percutaneous or procedures obtained improvement cholestatic indexes subsequent cholangitis. In two suppression allowed function. The present suggests that some may represent primary event leading secondary does not correlate specific but results stasis infection, recurrent eventually sclerosis. Aggressive research advised, since early nonsurgical prevent irreversible worsening prognosis metastatic disease.