Isolated Hyperthermic Hepatic Chemoperfusion in Patients with Colorectal Cancer and Isolated Non-Resectable Liver Metastases
The aim of the study was to evaluate the clinical efficacy of isolated hyperthermic hepatic chemoperfusion (IHHC) in patients with colorectal cancer and isolated non-resectable liver metastasis (M1c) resistant to systemic polychemotherapy (PCT).
Materials and Methods. The study included 6 patients with colorectal cancer with isolated non-resectable liver metastatic lesions resistant to systemic PCT. The average age of patients was 59.3±3.4 years. Before the IHHC, all patients received 2 cycles or more of PCT that failed to prevent an increase in metastatic foci in the liver. The IHHC was performed using an artificial circulation device; the chemotherapeutic agents (melphalan in combination with TNF-α) were administered through the gastroduodenal artery. Blood from the retro-hepatic segment of the inferior vena cava was collected after the liver vessels were completely isolated and a parallel circulation shunt was established for returning the blood into the superior vena cava from the inferior vena cava and the portal vein.
Results. In 3 patients with follow-up examinations at 3 and 6 months, a complete response (according to the mRECIST scores) was noted; in the other 3 patients, there was a partial response to the treatment. In patients with a complete response, the use of IHHC resulted in complete tumor pathomorphism confirmed by histology and spiral CT at 3 and 6 months after the procedure.
Conclusion. IHHC with melphalan and TNF-α can be used for regional chemotherapy in patients with isolated non-resectable metastases resistant to systemic chemotherapy.
- Leporrier J., Maurel J., Chiche L., Bara S., Segol P., Launoy G. A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer. Br J Surg 2006; 93(4): 465–474, https://doi.org/10.1002/bjs.5278.
- van Iersel L.B., Koopman M., van de Velde C.J., Mol L., van Persijn van Meerten E.L., Hartgrink H.H., Kuppen P.J., Vahrmeijer A.L., Nortier J.W., Tollenaar R.A., Punt C., Gelderblom H. Management of isolated nonresectable liver metastases in colorectal cancer patients: a case-control study of isolated hepatic perfusion with melphalan versus systemic chemotherapy. Ann Oncol 2010; 21(8): 1662–1667, https://doi.org/10.1093/annonc/mdp589.
- Tzeng C.-W.D., Aloia T.A. Colorectal liver metastases. J Gastrointest Surg 2013; 17(1): 195–201, https://doi.org/10.1007/s11605-012-2022-3.
- Alexander H.R. Jr., Libutti S.K., Bartlett D.L., Pingpank J.F., Kranda K., Helsabeck C., Beresnev T. Hepatic vascular isolation and perfusion for patients with progressive unresectable liver metastases from colorectal carcinoma refractory to previous systemic and regional chemotherapy. Cancer 2002; 95(4): 730–736, https://doi.org/10.1002/cncr.10686.
- Masi G., Vasile E., Loupakis F., Cupini S., Fornaro L., Baldi G., Salvatore L., Cremolini C., Stasi I., Brunetti I., Fabbri M.A., Puglisi M., Trenta P., Granetto C., Chiara S., Fioretto L., Allegrini G., Crinò L., Andreuccetti M., Falcone A. Randomized trial of two induction chemotherapy regimens in metastatic colorectal cancer: an updated analysis. J Natl Cancer Inst 2011; 103(1): 21–30, https://doi.org/10.1093/jnci/djq456.
- Rothenberg M.L., Cox J.V., Butts C., Navarro M., Bang Y.J., Goel R., Gollins S., Siu L.L., Laguerre S., Cunningham D. Capecitabine plus oxaliplatin (XELOX) versus 5-fluorouracil/folinic acid plus oxaliplatin (FOLFOX-4) as second-line therapy in metastatic colorectal cancer: a randomized phase III noninferiority study. Ann Oncol 2008; 19(10): 1720–1726, https://doi.org/10.1093/annonc/mdn370.
- Alexander H.R., Libutti S.K., Pingpank J.F., Bartlett D.L., Helsabeck C., Beresneva T. Isolated hepatic perfusion for the treatment of patients with colorectal cancer liver metastases after irinotecan-based therapy. Ann Surg Oncol 2005; 12(2): 138–144, https://doi.org/10.1245/aso.2005.05.003.
- Rothbarth J., Pijl M.E., Vahrmeijer A.L., Hartgrink H.H., Tijl F.G., Kuppen P.J., Tollenaar R.A., van de Velde C.J. Isolated hepatic perfusion with high-dose melphalan for the treatment of colorectal metastasis confined to the live. Br J Surg 2003; 90(11): 1391–1397, https://doi.org/10.1002/bjs.4308.
- Alexander H.R. Jr., Bartlett D.L., Libutti S.K., Pingpank J.F., Fraker D.L., Royal R., Steinberg S.M., Helsabeck C.B., Beresneva T.H. Analysis of factors associated with outcome in patients undergoing isolated hepatic perfusion for unresectable liver metastases from colorectal center. Ann Surg Oncol 2009; 16(7): 1852–1859, https://doi.org/10.1245/s10434-009-0482-9.
- Schwemmte K., Link K.H., Rieck B. Rationale and indications for perfusion in liver tumors: current data. World J Surg 1987; 11(4): 534–540, https://doi.org/10.1007/bf01655820.
- Aigner K., Walther H., Tonn J., Wenzl A., Hechtel R., Merker G., Schwemmle K. First experimental and clinical results of isolated liver perfusion with cytotoxics in metastases from colorectal primary. Recent Results in Cancer Research 1983; 86: 99–102, https://doi.org/10.1007/978-3-642-82025-0_18.
- World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310(20): 2191–2194, https://doi.org/10.1001/jama.2013.281053.
