A Cochrane review 2 (abstract , review [Abstract]) included 7 studies with a total of 592 subjects who had resection of colorectal cancer metastatic to the liver. The control groups were either treated by surgery alone or surgery followed by systemic chemotherapy. No significant advantage was found in the meta-analysis for hepatic artery chemotherapy measuring overall survival and calculating survival based upon "intention to treat" (lnHR = 0.0848; favouring the control group, 95% confidence interval = -0.1189 to 0.2885, or a Hazard Ratio of 1.089, an 8.9% survival advantage for the control group, 95% CI of the HR = 0.887 - 1.334). Adverse events related to the hepatic artery therapy were common, including five therapy related deaths. Intra-hepatic recurrence was more frequent in the control group (97 patients versus 43 in the HAI group), though denominators are not reported, and additional outcomes could not be subjected to a combined analysis.
Comment: The quality of evidence is downgraded by study quality (lack of blinding) and by imprecise results (few patients and wide confidence intervals).
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