A case of hepatic metastasis of colon carcinoma, treated by arterial infusion of methotrexate, fluorouracil, and leucovorin

A 56-year-old man was admitted to hospital due to ileus resulting from advanced colon carcinoma with multiple liver metastases. He underwent right hemicolectomy, and was treated by sequential, hepatic arterial infusions of methotrexate and 5-fluorouracil, followed by leucovorin rescue as a postoperative chemotherapy, using a subcutaneously implantable drug delivery system. The catheter was placed into the hepatic artery, via the gastroduodenal artery, at surgery. Chemotherapy consisted of methotrexate (50 mg/body) bolus arterial infusion and 5-fluorouracil (500 mg/body) arterial infusion, for 2 hours at hour 24 after methotrexate, followed by oral leucovorin (15 mg/body), started at hour 30 after methotrexate, 6 times, at intervals of 6 hours. Methotrexate-5-fluorouracil-leucovorin was administered almost every week for 5 months, and every other week thereafter, at an outpatient clinic. After 5 months, carcinoembryonic antigen and carbohydrate antigen 19–9 levels had declined markedly from 3365 to 58 ng/mL and 1047 to 436 U/mL, respectively. Abdominal CT showed significant remission (70% in area) of the hepatic metastases. Performance status of the patient was improved from grade 3 to grade 0, and he has been alive and well for 15 months. This case clearly demonstrates the feasibility of methotrexate-5-fluorouracil-leucovorin, administered via hepatic arterial infusion, in managing multiple liver metastases from colorectal carcinoma.