High-dose radiation with concurrent hepatic arterial floxuridine in patients with unresectable intrahepatic malignancies

A phase II trial was conducted to determine if high-dose radiation with concurrent hepatic arterial floxuridine would improve survival in patients with unresectable intrahepatic malignancies. With 3D planning, 128 patients received a median radiation dose of 60.75 Gy (range 40-90 Gy). The total radiation dose, based on a normal-tissue complication probability model developed at the University of Michigan , subjected the patient to an estimated maximum risk of radiation-induced liver disease of 10-15%. At a median follow-up of 16 months (26 months in patients alive) the median survival was 15.8 months, significantly longer than in historical controls. The 3-year survival was 17%.  The total dose was the most important significant predictor of survival. Toxicity was acceptable with 30% developing grade 3/4 toxicity, and one treatment-related death. 

We concluded that this regimen appears to prolong survival of patients with unresectable primary hepatobiliary tumors and chemotherapy-refractory metastatic colorectal cancer. This provides a treatment option to the former group of patients for whom there is no other effective therapy. In the latter group, this regimen can be combined with the most advanced systemic therapy available to these patients.

Reference:

Ben-Josef E. et al.: "Phase II Trial of High-Dose Conformal Radiation Therapy With Concurrent Hepatic Artery Floxuridine for Unresectable Intrahepatic Malignancies", J Clin Oncol. 2005 Dec 1;23(34):8739-47

Edgar Ben-Josef

Department of Radiation Oncology, University of Michigan, Ann Arbor, MI