Since 1964, 200 patients were treated with intra-arterial 5-FU infusion. Of them, 127 failed with intravenously injected 5-FU, and 27 were unsuitable for such treatment as their involvement was so far advanced as to have jaundice d u e to extensive parenchymal involvement. In all b u t 12 patients, the catheter was placed percutaneously through the brachial artery. The criteria for improvement included a t least a 6-cm decrease in distance of the liver edge from the xiphoid or costal margin, a 50% decrease in the abnormal enzyme studies, a return of elevated bilirubin levels to normal so that jaundice disappeared, a n d all these responses continued for at least 2 months. Inpatients were treated with 5-FU, 25 mg/kg/day x 4, then 15 mg/kg/day for 7 o r 8 days. If no toxicity appeared, the 5-FU was then increased to 20 mg/kg/day until the total infusion period was 21 days, and the catheter was removed. Outpatients received 500 m g daily in 140 m l 5% dextrose and 2,500 units heparin daily for 90 days, and then the catheter was removed. Following the termination of the infusion, the patient was given weekly intravenous doses of 5-FU at 15 mg/kg. After several months, with reactivation of the disease, the intra-arterial infusion was repeated. Minimal toxicity occurred, a n d there was one death from the procedure. Morbidity in the forms of infection and hemorrhage did occur, but, i n the last 100 patients, there were only 2 minor infections. Of 113 study patients, 69 (61%) met o u r criteria of improvement and had a median survival of 8.7 months. Forty-four (39%) failed, and their median survival was 2.5 months. This demonstrates a significantly increased survival in the responders.
RIOR TO THE ADVENT OF INTRA-ARTERIAL IN-
P fusion, patients with progressive metastases to the liver, most frequently of gastrointestinal origin, were usually doomed to a rapid downhill course after failure with 5-fluorouracil (5-FU) given by the conventional intravenous route.
Delivering chemotherapy directly to the tumor through its arterial supply was initiated in 1950, by Bierman et al.4 and Klopp et a1. O and repopularized, in 1959, by Sullivan et al.