Carcinoembryonic antigen and intra-arterial chemotherapy response of liver metastases.

Background/aims: We investigated the relationship between serum carcinoembryonic antigen and response to hepatic artery chemotherapy for unresectable colorectal liver metastases.

Methodology: The study included 14 patients with unresectable colorectal liver metastases receiving hepatic arterial chemotherapy weekly. Patients were evaluated monthly including liver function tests and carcinoembryonic antigen. Ten patients received high dose 5-fluorouracil (1000 mg/m2) and 4 patients received other regimens. One patient underwent hepatectomy for cure after 5-fluorouracil.

Results: Thirteen patients (93%) had normal quality of life without toxicity during hepatic artery infusion. Response rate in the high dose 5-fluorouracil group was 50%, while the response rate of other regimens was 25%. Mean survival time differed between responding (n = 6) and non-responding patients (n = 8) (527 vs 289 days), and the high dose 5-fluorouracil (n = 10) and other regimens (n = 4) (462 vs 213 days). In responding patients, peak serum carcinoembryonic antigen levels before hepatic artery infusion decreased within 6 months. In the non-responding patients, serum carcinoembryonic antigen levels increased rapidly despite hepatic artery infusion.

Conclusions: Serum carcinoembryonic antigen levels correlated well with response. Hepatic artery infusional chemotherapy with high dose 5-fluorouracil may be recommended as effective treatment for unresectable liver metastasis from colorectal cancer if serum carcinoembryonic antigen levels decrease within 6 months.