Dr. François Quenet, oncological surgeon at Quenet-Torrent Institute, has recently taken part in a scientific article comparing the results of postoperative hepatic arterial infusion (HAI) chemotherapy versus postoperative intravenous chemotherapy in patients operated on for liver metastases from colorectal cancer.
The study, "Postoperative Hepatic Arterial Infusion With Oxaliplatin After Surgery of Four or More Colorectal Liver Metastases: A Randomized Phase II Trial", was published in Journal of Clinical Oncology (J Clin Oncol 2026 May 20;44(15):1416-1429. doi: 10.1200/JCO-25-01737).
What the trial showed
This phase II clinical trial studied whether administering oxaliplatin by hepatic arterial infusion after surgery in patients with four or more liver metastases from colorectal cancer could reduce the risk of relapse compared with conventional intravenous administration. It included 99 patients who, after complete resection of their metastases, received systemic chemotherapy combined with oxaliplatin by one of the two routes.
The results showed that hepatic arterial infusion achieved better disease control in the liver:
- It roughly doubled hepatic recurrence-free survival (25 vs 12 months), a clinically relevant benefit.
- It improved overall disease-free survival (14 vs 9 months).
- Overall survival was higher in the hepatic arterial group (74 vs 57 months), although this difference did not reach statistical significance.
The treatment was associated with a higher frequency of severe toxicities (58% vs 32%), but was considered feasible and manageable. Overall, the study suggests that postoperative hepatic arterial infusion of oxaliplatin could become an effective strategy to reduce relapse after surgery for multiple colorectal liver metastases, although its benefits must be confirmed in a phase III trial.
These data reinforce the fact that at Quenet-Torrent Institute we have been using hepatic arterial infusion chemotherapy for years across different indications. Below we outline the most frequent indications for this type of treatment.
What is hepatic arterial infusion (HAI)?
Hepatic arterial infusion (HAI) consists of delivering chemotherapy directly into the hepatic artery through a catheter connected to an implantable pump. Its rationale is that colorectal liver metastases receive most of their blood supply from the hepatic artery, whereas the normal liver depends mainly on the portal vein.
HAI remains a technique used in highly specialized centers, with the greatest accumulated experience at Memorial Sloan Kettering Cancer Center and some European groups, such as Quenet-Torrent Institute.
Current status in the guidelines
The main international guidelines, including the European Society for Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN), consider HAI a specialized strategy that may be considered in experienced centers, but do not recommend it as a universal standard for all patients with colorectal liver metastases.
The best-supported indications are:
- Initially unresectable liver disease with the aim of conversion to surgery.
- Adjuvant treatment after resection of liver metastases in very high-risk patients.
- Predominantly hepatic disease after failure of systemic lines.
1. Converting unresectable liver metastases into resectable ones
This is probably the indication with the widest clinical acceptance.
Candidate patients
- Metastases limited to the liver or clearly dominated by the hepatic burden.
- Initially unresectable disease.
- Good functional status.
- No significant extrahepatic progression.
Evidence
Several Memorial Sloan Kettering Cancer Center series show conversion-to-surgery rates close to 40-50% when HAI is combined with modern systemic chemotherapy. The goal is to achieve maximum tumor reduction, an R0 resection and increased long-term survival. Many experts now consider this the strongest indication for HAI.
2. Adjuvant treatment after resection of liver metastases
This is exactly where the trial mentioned above fits, in which Dr. François Quenet took part.
Rationale
After a curative hepatectomy, up to 70% of patients relapse, and the liver is the first site of recurrence in many cases. HAI aims to eradicate residual microscopic hepatic disease.
Who would be the best candidates?
High-risk factors:
- ≥4 liver metastases.
- Bilobar metastases.
- Large tumor size.
- Multiple resection.
- High Clinical Risk Score.
- Suboptimal response to preoperative chemotherapy.
Recent evidence
The French trial by Gelli et al. (JCO 2026) showed a roughly doubled hepatic recurrence-free survival, improved disease-free survival and a favorable trend in overall survival. These results have rekindled interest in adjuvant HAI, although confirmation in phase III studies is still awaited before widespread adoption.
3. Refractory predominantly hepatic disease
Patients already treated with FOLFOX and FOLFIRI, frequently exposed to biologics. If progression is concentrated in the liver, HAI can offer:
- Prolonged local control.
- Delay of tumor-related liver failure.
- Possible tumor reduction for subsequent strategies.
The evidence is weaker than for conversion or adjuvant settings, but it remains an option considered in expert centers.
Situations where it is usually NOT indicated
Extensive extrahepatic metastases
HAI controls the liver but has little impact on widespread systemic disease. It is therefore generally not recommended when there are multiple progressive lung metastases, extensive peritoneal carcinomatosis or multi-organ involvement.
Patients with impaired liver function
Special caution is needed in significant cirrhosis, sclerosing cholangitis, biliary obstruction or liver failure.
Limitations of the technique
The main reason HAI has not become widespread is its technical complexity. It requires experienced hepatobiliary surgeons, interventional radiologists, oncologists with specific expertise and the management of implantable infusion pumps.
Possible complications include arterial thrombosis, catheter displacement, biliary toxicity, cholangitis, biliary sclerosis and hepatic toxicity. The incidence of complications has decreased markedly in high-volume centers.
Our experience at Quenet-Torrent Institute
At Quenet-Torrent Institute we have been using hepatic arterial infusion chemotherapy for years, integrated into a multidisciplinary approach to colon cancer and rectal cancer with liver metastases. The combination of highly complex hepatobiliary surgery, interventional radiology and medical oncology allows us to select the patients who benefit most from this technique.