DIE INTRAARTERIELLE CHEMOTHERAPIE MIT 5-FU UND FOLINSAURE (FA, RESCUVOLIN®) IM THERAPIEKONZEPT BEI NICHT RESEKTABLEN KOLOREKTALEN LEBERMETASTASEN. EIN VERGEICH VON 5-FU/FA I.V. VS. 5-FUDR I.A. ODER 5-FUDR I.A. + I.V.

Various prospective studies with fluoropyrimidines were conducted at the Ulm University Hospital in patients with metastasized colorectal carcinomas. We compared the effectivities and toxicities of these systemic (i.v.) and intraarterial (i.a.) protocols using 5-FU/folinic acid (FA) i.v., 5-FU/FA i.a., 5-FUDR i.a., and 5-FUDR i.a. + i.v., to find out the best treatment in isolated nonrespectable colorectal liver metastases (CRLM). 34 patients with metastasized colorectal carcinoma received 5-FU/FA i.v. (400 mg/m² + 170 mg/m², 2 h + 10 min, d 1-5, q 4 w), 26 patients with CRLM ± extrahepatic metastases 5-FU/FA i.a. (600 mg/m² + 170 mg/m², 2 h + 10 min, d 1-5, q 4 w) via portcatheters, 23 patients with CRLM 5-FUDR i.a. (0.2 mg/kg/d, d 1-14, q 2 w), and 21 patients with CRLM 5-FUDR i.a. + i.v. (0.3 mg/kg/d, d 1-14, q 2 w) via totally implantable infusion pumps. The response rates for 5-FU/FA i.v., 5-FU/FA i.a., 5-FUDR i.a., and 5-FUDR i.a. + i.v. were 29%, 48%, 52%, and 48%, respectively. 5-FU/FA i.v. and 5-FU/FA i.a. induced toxicitics ≥ WHO III were 1% or 5-8%, respectively, and 1 patient died of gastrointestinal/hematologic toxicity. 5-FU/FA i.a. had no regional toxicity, while 5-FUDR i.a. and 5-FUDR i.a. + i.v. induced a sclerosing cholangitis in 26% and 24%, and gastroduodenal ulcer disease in 26% and 24%. 1 patient died of sclerosing cholangitis. Peripheral venous plasma levels during 5-FU i.a. infusions were comparable with i.v. levels in systemic 5-FU treatment protocols. Regarding the relation of effectivity/toxicity and considering the systemic levels during 5-FU i.a. infusion as an advantage, 5-FU/FA seems to be the optimal treatment in CRLM.