Background: Esophageal adenocarcinomas frequently metastasize to the liver. Systemic chemotherapies have response rates of 30%, with median survival of 6-10 months. Survival after failure of first-line systemic therapy is dismal with medians of 4.5-6.5 months in salvage trials. We evaluated the efficacy of hepatic artery chemoembolization of liver-dominant metastases from primary esophageal adenocarcinoma.

Methods: 8 patients were chemoembolized with cisplatinum, doxorubicin, mitomycin-C, Ethiodol, and polyvinyl alcohol particles at monthly intervals for 1-3 sessions. 7/8 had progressed on systemic chemotherapy and one received systemic therapy concurrently. Imaging, clinical, and laboratory evaluation were performed prior to treatment, one month after, and every three months thereafter. Morphologic response (RECIST), toxicities (CTCAE v. 3.0), and mortality were measured. Kaplan-Meier analyses were then performed to determine time to progression and survival from time of diagnosis and time of first treatment.

Results: 14 chemoembolizations were performed over 9 treatment cycles. One to three sessions were performed per treatment cycle with a mean of --1.4 sessions per treatment cycle. There were two Grade 3 toxicities (both fatigue) and none Grade 4. 30-day mortality was 0%. Follow-up from last chemoembolization was 1-13 months (mean 4 months). Five patients developed intra-hepatic progression, two were stable at last imaging, and follow-up imaging was unavailable for one. Three patients developed extra-hepatic disease progression (lung, brain, L3 vertebrae) at a median time of 3 months. 1-year survival from primary diagnosis was 86% (median 20 months), from diagnosis with metastases 71% (median 17 months), and from first chemoembolization 23% (median 10 months).

Conclusions: In this small series, chemoembolization of hepatic metastases from esophageal adenocarcinoma was well tolerated and provided median survival superior to that reported for systemic chemotherapy, particularly when compared to salvage trials.