TACE of liver metastases from colorectal cancer adopting irinotecan-eluting beads: Beneficial effect of palliative intra-arterial lidocaine and post-procedure supportive therapy on the control of side effects

Background/Aims: Colorectal cancer is one of the most significant health emerging problem in western countries. Patients with colorectal cancer have liver metastases at presentation in about 25% of cases and another 50% will develop liver recurrence within the next 5 years. Intra-arterial hepatic chemoembolization (TACE) could be a new therapeutic opportunity in the treatment of unresectable or chemorefractory metastases. Methodology: Since November 2005 we performed a clinical trial of TACE with irinotecan-eluting beads (DEBIRI) in 20 patients affected by liver metastases from colorectal cancer as palliative setting. We developed an intensive treatment with intra-arterial lidocaine and post-procedure supportive therapy to reduce acute toxic effects. Results: We observed a high response rate (80%), with reduction of lesional contrast enhancement in all responding patients. Due to the supportive treatment, TACE was well tolerated by most patients with a median duration of hospitalization of 3 days (range 1-10). The most important adverse event was abdominal pain. Supportive treatment with antibiotic and antiemetic prophylaxis, and intravenous hydration is strictly necessary until stabilization of serum levels of transaminases and to prevent infections. Major analgesic as morphine and intra-arterial lidocaine must be used before the procedure. Conclusions: Our results suggest that TACE using DEBIRI feasible in pretreated patients with liver metastases from CRC adopting an adequate supportive therapy to reduce side effects.