Isolation perfusion of the liver

Area of Science:

• Oncology
• Surgical Oncology
• Regional Cancer Therapy

Background:

• Unresectable primary and metastatic liver cancers pose a significant mortality challenge.
• Current systemic therapies often have limited efficacy and severe toxicities for advanced liver disease.

Purpose of the Study:

• To evaluate the efficacy and potential of Isolated Hepatic Perfusion (IHP) as a regional treatment strategy for unresectable liver cancers.
• To explore the use of intensified drug delivery within the liver to overcome treatment resistance.

Main Methods:

• Isolated Hepatic Perfusion (IHP) involves isolating the liver's vascular supply and perfusing it with therapeutic agents via an extracorporeal circuit.
• Commonly used agents include melphalan, hyperthermia, and tumor necrosis factor.
• Combination therapy with hepatic arterial infusion of floxuridine post-IHP was investigated for colorectal cancer metastases.

Main Results:

• IHP demonstrates anti-tumor efficacy in patients with advanced liver disease, including large tumors and high tumor burden.
• Positive responses are observed in patients whose cancers are refractory to conventional systemic and hepatic arterial infusion chemotherapy.
• Combining IHP with hepatic arterial infusion of floxuridine shows significant and durable response rates in colorectal cancer metastases.

Conclusions:

• Isolated Hepatic Perfusion (IHP) is a promising regional therapy for unresectable liver cancers, including primary and metastatic disease.
• IHP allows for intensified treatment delivery to the liver, potentially overcoming resistance to systemic therapies.
• Further clinical trials are warranted to establish the role of IHP in the management of unresectable liver metastases.